ABSTRACT
Objective: We aimed to investigate the associations between new-onset neurological symptoms (NNS) and mortality, respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, length of ICU and hospital stay among COVID-19 patients. Background: Current reports of neurological symptoms/signs, complications, and outcomes of COVID-19 infection are limited due to the small number of included patients and relatively short duration of data collection which could hinder more precise estimates and detection of rarer manifestations. Design/Methods: We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines. Results: We included a total of 10,881 patients with confirmed COVID-19 infection (2,008 had NNS;8,873 did not have NNS). The most common NNS were headache (n = 607, 5.58%), anosmia/hyposmia (n = 544, 5.0%), and altered sensorium (n = 479, 4.4%). The adjusted hazard ratios (aHRs) for mortality among the mild and severe cases were significantly higher by 1.660 (95% CI 1.132-2.435) and by 1.352 (95% CI 1.042-1.752), respectively, in the NNS group compared to those in the non-NNS group. The aHRs for respiratory failure in the NNS group were significantly increased by 1.914 (95% CI 1.346-2.722), by 1.614 (95% CI 1.260-2.068), and by 1.234 (95% CI 1.089-1.398) among the mild, severe, and critical cases, respectively. The aHRs for ICU admission in the NNS group were still significantly higher by 1.973 (95% CI 1.457-2.673) and by 1.831 (95% CI 1.506-2.226) among the mild and severe cases, respectively. Patients who had NNS were not significantly associated with a longer duration of ventilator dependence (adjusted odds ratio (aOR) 0.954, 95% CI 0.772-1.179), longer ICU stay (aOR 0.983, 95% CI 0.772-1.252) and longer hospital admission (aOR 1.045, 95% CI 0.947-1.153). Conclusions: The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients.