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EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-308461


Background: Pre-existing diseases are considered risk factors for severe COVID-19 and death. However, there is lack of consolidated global data on this risk among individuals with pre-existing neurological disease.Aim: Investigate the impact of pre-existing neurological disease on the clinical course and outcome of COVID-19.Methods: A rapid review of literature from PubMed and the World Health Organization (WHO) COVID-19 database was conducted for articles published between 1st January 2020 and 4th April 2021. The review included individuals with COVID-19 and pre-existing neurological disease using pre-generated search terms to capture chronic neurological diseases in all age-groups. Articles included in the review were systematic reviews and meta-analysis, cohort studies, retrospective studies, case-control studies and case series. From the included studies, demographic data and Odds Ratios (OR) were extracted, and pooled ORs were generated for the outcomes of COVID-19 severity and death.Results: Twenty-six articles from 12 countries across three continents with a total of 379,947 COVID-19 patients was included. The mean age was 57 years (SD 10.93), 51.3% of whom were female. Pre-existing neurological disease, particularly cerebrovascular disease and dementia, was shown to be a risk factor for severe COVID-19 with a pooled OR of 1.99 (1.81 – 2.18). There was also an increased risk of death with a pooled OR for pre-existing neurological disease overall of 1.74 (1.56 – 1.94).Conclusion: The findings suggest that pre-existing neurological disease is a significant risk factor for severe COVID-19 and mortality. Further investigations to consolidate these findings are required through large multi-national cohort studies.

Eur J Neurol ; 28(12): 3925-3937, 2021 12.
Article in English | MEDLINE | ID: covidwho-1515204


BACKGROUND AND PURPOSE: During acute coronavirus disease 2019 (COVID-19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real-world data from a multinational registry. METHODS: We analyzed COVID-19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS-Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. RESULTS: A total of 6537 COVID-19 patients (97.7% PCR-confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB; 2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20-1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07-1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19. CONCLUSION: Our data on mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICB in critical COVID-19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life-threatening systemic viral infection.

COVID-19 , Neurodegenerative Diseases , Stroke , Headache , Humans , SARS-CoV-2
Infection ; 48(4): 619-626, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-597401


PURPOSE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide causing a global health emergency. Pa-COVID-19 aims to provide comprehensive data on clinical course, pathophysiology, immunology and outcome of COVID-19, to identify prognostic biomarkers, clinical scores, and therapeutic targets for improved clinical management and preventive interventions. METHODS: Pa-COVID-19 is a prospective observational cohort study of patients with confirmed SARS-CoV-2 infection treated at Charité - Universitätsmedizin Berlin. We collect data on epidemiology, demography, medical history, symptoms, clinical course, and pathogen testing and treatment. Systematic, serial blood sampling will allow deep molecular and immunological phenotyping, transcriptomic profiling, and comprehensive biobanking. Longitudinal data and sample collection during hospitalization will be supplemented by long-term follow-up. RESULTS: Outcome measures include the WHO clinical ordinal scale on day 15 and clinical, functional, and health-related quality-of-life assessments at discharge and during follow-up. We developed a scalable dataset to (i) suit national standards of care, (ii) facilitate comprehensive data collection in medical care facilities with varying resources, and (iii) allow for rapid implementation of interventional trials based on the standardized study design and data collection. We propose this scalable protocol as blueprint for harmonized data collection and deep phenotyping in COVID-19 in Germany. CONCLUSION: We established a basic platform for harmonized, scalable data collection, pathophysiological analysis, and deep phenotyping of COVID-19, which enables rapid generation of evidence for improved medical care and identification of candidate therapeutic and preventive strategies. The electronic database accredited for interventional trials allows fast trial implementation for candidate therapeutic agents. TRIAL REGISTRATION: Registered at the German registry for clinical studies (DRKS00021688).

Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Registries , Berlin/epidemiology , Betacoronavirus , Biological Specimen Banks , COVID-19 , Coronavirus Infections/epidemiology , Disease Management , Humans , Observational Studies as Topic , Pandemics , Phenotype , Pneumonia, Viral/epidemiology , Prospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Time Factors , Treatment Outcome , World Health Organization