Impact of COVID- 19 Infection Among Hospitalized Amyotrophic Lateral Sclerosis Patients.

The novel positive-stranded RNA coronavirus-19 (COVID-19), causing the current global pandemic, has around 10% mortality rate. Clinical presentation varies from fever, mild cough, and sore throat to pneumonia/ARDS and multi-organ failure.[1] Comorbid conditions such as hypertension, diabetes, chronic obstructive pulmonary disease, and asthma are suspected to increase the risk of COVID-19-related complications.[2] Infection with the COVID-19 virus poses many challenges in the course of various neuromuscular diseases including amyotrophic lateral sclerosis (ALS) because of the risk of respiratory complications.

For our study, we used Cerner Real-World Data that was provided through Cerner's HealtheDataLab research tool.[3] The COVID-19 dataset in HealtheDataLab contains de-identified patient data of 117,000 patients from 62 contributing health systems. The dataset contains all patients that were tested for COVID-19 at some point during their visits to one of the 62 health centers. To begin with, all patients having the ALS who were tested for COVID-19 were identified using ICD-9-CM codes (335.29, 335.20), ICD-10-CM code (G12.21) and SNOMED-CT code (86044005). This yielded a total of 19 ALS patients that were tested either positive or negative for COVID-19. From these 19 patients, a total of 6 patients were tested positive and hospitalized.

Of the 6 patients, 5 patients were Caucasians, and one was Hispanic. Male to female ratio was 66.7%: 33.3% with a mean age of 62.1 years (range 49–72 years). Two of the patients had bulbar onset, and 4 of them had limb onset ALS. Two of 6 (33.3%) patients were wheelchair-dependent, and the ALSFRS-R score ranged from 22 to 36 in 6 patients. The major comorbid conditions identified in these patients were hypertension (66.6%), obesity, diabetes mellitus type-2 (50%), cardiovascular problems (33.3%), hyperlipidemia (33.3%), dementia, progressive supranuclear ophthalmoplegia, pseudo bulbar affect, vertebral artery stenosis, and chronic kidney disease. Only one patient was on riluzole, and none of them were on Edaravone. The number of hospitalization days in these patients ranged from 3 to 27 days. All of them had COVID-19 pneumonia. Of them, 2 (33.3%) deceased from sepsis, multi-organ failure, and respiratory failure. Two patients were discharged to a skilled nursing facility; one patient was discharged to home hospice, and one patient to inpatient rehabilitation.

In a nation-wide analysis in China, 2 or more comorbidities were observed in all patients with severe COVID-19 disease with resultant increased the risk of poorer outcomes.[4] The prevalence of comorbidities in all 6 ALS patients was like previously reported studies. Around 5% of patients with COVID-19 develop multi-organ dysfunction and sepsis secondary to dysregulated host immune response.[5] Sepsis worsens the clinical outcome of COVID-19 patients.[5]

ALS patients with co-existing medical comorbidities can be at higher risk of COVID-19 infection and its complications. There are some limitations to our study, intricate details of in-hospital admission could not be retrieved, and small number making it harder to generalize the findings. Larger studies are needed to shed light on impact of COVID-19 on ALS patients with or without co-existing comorbidities.