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Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis.
Singh, Bhagteshwar; Lant, Suzannah; Cividini, Sofia; Cattrall, Jonathan W S; Goodwin, Lynsey C; Benjamin, Laura; Michael, Benedict D; Khawaja, Ayaz; Matos, Aline de Moura Brasil; Alkeridy, Walid; Pilotto, Andrea; Lahiri, Durjoy; Rawlinson, Rebecca; Mhlanga, Sithembinkosi; Lopez, Evelyn C; Sargent, Brendan F; Somasundaran, Anushri; Tamborska, Arina; Webb, Glynn; Younas, Komal; Al Sami, Yaqub; Babu, Heavenna; Banks, Tristan; Cavallieri, Francesco; Cohen, Matthew; Davies, Emma; Dhar, Shalley; Fajardo Modol, Anna; Farooq, Hamzah; Harte, Jeffrey; Hey, Samuel; Joseph, Albert; Karthikappallil, Dileep; Kassahun, Daniel; Lipunga, Gareth; Mason, Rachel; Minton, Thomas; Mond, Gabrielle; Poxon, Joseph; Rabas, Sophie; Soothill, Germander; Zedde, Marialuisa; Yenkoyan, Konstantin; Brew, Bruce; Contini, Erika; Cysique, Lucette; Zhang, Xin; Maggi, Pietro; van Pesch, Vincent; Lechien, Jérome.
  • Singh B; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Lant S; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
  • Cividini S; Department of Infectious Diseases, Christian Medical College, Vellore, India.
  • Cattrall JWS; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Goodwin LC; Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom.
  • Benjamin L; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Michael BD; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Khawaja A; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
  • Matos AMB; Queen Square Institute of Neurology, University College London, London, United Kingdom.
  • Alkeridy W; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Pilotto A; The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
  • Lahiri D; Department of Neurology, Wayne State University, Detroit, Michigan, United States of America.
  • Rawlinson R; Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil.
  • Mhlanga S; Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
  • Lopez EC; Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy.
  • Sargent BF; Bangur Institute of Neurosciences, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
  • Somasundaran A; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Tamborska A; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Webb G; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Younas K; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Al Sami Y; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Babu H; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Banks T; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Cavallieri F; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Cohen M; Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.
  • Davies E; Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India.
  • Dhar S; Department of Infection, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland.
  • Fajardo Modol A; Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Farooq H; Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland.
  • Harte J; Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland.
  • Hey S; Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India.
  • Joseph A; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
  • Karthikappallil D; Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland.
  • Kassahun D; Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.
  • Lipunga G; Department of Infectious Diseases & Tropical Medicine, North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland.
  • Mason R; Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.
  • Minton T; Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland.
  • Mond G; Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom of Great Britain and Northern Ireland.
  • Poxon J; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Rabas S; Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland.
  • Soothill G; Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland.
  • Zedde M; North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland.
  • Yenkoyan K; Epsom and St Helier University Hospitals NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland.
  • Brew B; King's College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.
  • Contini E; Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, United Kingdom of Great Britain and Northern Ireland.
  • Cysique L; Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Zhang X; Yerevan State Medical University named after Mkhitar Heratsi, Neuroscience Laboratory, Cobrain Center, Yerevan, Armenia.
  • Maggi P; St Vincent's Hospital, Sydney, Australia.
  • van Pesch V; St Vincent's Hospital, Sydney, Australia.
  • Lechien J; St Vincent's Hospital, Sydney, Australia.
PLoS One ; 17(6): e0263595, 2022.
Article in English | MEDLINE | ID: covidwho-1875082
ABSTRACT

BACKGROUND:

Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome.

METHODS:

We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models.

RESULTS:

We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region.

INTERPRETATION:

Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Stroke / COVID-19 Type of study: Prognostic study / Reviews Topics: Long Covid Limits: Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0263595

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Stroke / COVID-19 Type of study: Prognostic study / Reviews Topics: Long Covid Limits: Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0263595