Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis.
Journal: PloS one
Volume: 17
Issue: 6
Year of Publication: 2022
Affiliated Institutions: 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. Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom. Queen Square Institute of Neurology, University College London, London, United Kingdom. Department of Neurology, Wayne State University, Detroit, Michigan, United States of America. Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil. Department of Medicine, King Saud University, Riyadh, Saudi Arabia. Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy. Bangur Institute of Neurosciences, Institute of Post-Graduate Medical Education and Research, Kolkata, India. Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland. Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India. Department of Infection, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland. Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland. Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland. Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland. Department of Infectious Diseases & Tropical Medicine, North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland. Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom of Great Britain and Northern Ireland. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi. Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland. Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland. North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland. Epsom and St Helier University Hospitals NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland. King's College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland. Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, United Kingdom of Great Britain and Northern Ireland. Yerevan State Medical University named after Mkhitar Heratsi, Neuroscience Laboratory, Cobrain Center, Yerevan, Armenia. St Vincent's Hospital, Sydney, Australia. Saint-Luc University Hospital, Brussels, Belgium. Université de Mons, Mons, Belgium. AZ Glorieux, Ronse, Belgium. Hospital da Restauração, Recife, Brazil. Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil. Hospital Dr. Sótero del Río, Santiago, Chile. Universidad de Chile - Hospital Barros Luco Trudeau, Santiago, Chile. The th Hospital of Joint Logistic Support Force of the People's Liberation Army, Lanzhou, China. Cairo University Hospital, Cairo, Egypt. Kasr Alainy Teaching Hospital, Cairo, Egypt. Mataria Teaching Hospital, Cairo, Egypt. Fondation Rothschild, Paris, France. Pitié Salpetriere Hospital, Paris, France. Rennes University Hospital, Rennes, France. Hôpitaux Universitaires de Strasbourg, Strasbourg, France. Children's Hospital, Dresden Municipal Hospital Teaching Hospital TUD, Dresden, Germany. Medical Center University of Freiburg, Freiburg, Germany. Department of Neurology, Technical University of Munich, Munich, Germany. Mazandaran University of Medical Science, Sari, Islamic Republic of Iran. Institute for Research in Fundamental Sciences (IPM), Tehran, Islamic Republic of Iran. Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran. Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy. University of Brescia, Brescia, Italy. San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy. Fondazione Mondino IRCCS, Pavia, Italy. Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. University Hospital of Rome Tor Vergata, Rome, Italy. Healthcare Trust of the Autonomous Region of Trento, Rovereto, Italy. Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Turin, Italy. University of Verona, Verona, Italy. Halcyon Healthcare Limited, Nairobi, Kenya. Hôpitaux Robert Schuman, Luxembourg, Luxembourg. Leiden University Medical Center, Leiden, Netherlands. Hospital Regional Docente de Trujillo, Trujillo, Peru. Centro Hospitalar São João, Porto, Portugal. Centro Hospitalar Universitário do Porto, Porto, Portugal. Buyanov Moscow City Hospital, Moscow, Russian Federation. Moscow Research and Clinical Center for Neuropsychiatry and Buyanov Moscow City Hospital, Moscow, Russian Federation. National Neuroscience Institute, Singapore, Singapore. Complejo Hospitalario Universitario de Albacete, Albacete, Spain. Hospital Universitario Virgen de las Nieves, Granada, Spain. University Hospital Sanchinarro, Madrid, Spain. University Hospital Ramón y Cajal, Madrid, Spain. Hospital Virgen de la Salud, Toledo, Spain. Hospital del Río Hortega, Valladolid, Spain. Hopitaux Universitaires de Genève, Geneva, Switzerland. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Acibadem Mehmet Ali Aydinlar University Medical School, Istanbul, Turkey. Ulster Hospital, Belfast, United Kingdom of Great Britain and Northern Ireland. University of Bristol and North Bristol NHS Trust, Bristol, United Kingdom of Great Britain and Northern Ireland. Gloucestershire Royal Hospital, Gloucester, United Kingdom of Great Britain and Northern Ireland. Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom. The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom. Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland. Imperial College London, London, United Kingdom of Great Britain and Northern Ireland. The National Hospital for Neurology & Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland. University College London, London, United Kingdom of Great Britain and Northern Ireland. University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland. Eastern Pathology Alliance Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom of Great Britain and Northern Ireland. Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland. Wessex Neurological Centre, Southampton, United Kingdom of Great Britain and Northern Ireland. Emory University School of Medicine, Atlanta, Georgia, United States of America. Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, United States of America. Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, United States of America. Rush University Medical Center, Chicago, Illinois, United States of America. University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America. Children's Hospital Los Angeles and Keck School of Medicine at the University of Southern California, Los Angeles, California, United States of America. Ochsner Medical Center, New Orleans, Los Angeles, United States of America. Columbia University Irving Medical Center, New York, New York, United States of America. New York University Grossman School of Medicine, New York, New York, United States of America. Department of Neurology, National Neuroscience Institute, Singapore, Singapore. Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom. Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Abstract summary
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.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.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.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.Authors & Co-authors: Singh Lant Cividini Cattrall Goodwin Benjamin Michael Khawaja Matos Alkeridy Pilotto Lahiri Rawlinson Mhlanga Lopez Sargent Somasundaran Tamborska Webb Younas Al Sami Babu Banks Cavallieri Cohen Davies Dhar Fajardo Modol Farooq Harte Hey Joseph Karthikappallil Kassahun Lipunga Mason Minton Mond Poxon Rabas Soothill Zedde Yenkoyan Brew Contini Cysique Zhang Maggi van Pesch Lechien Saussez Heyse Brito Ferreira Soares Elicer Eugenín-von Bernhardi Ñancupil Reyes Yin Azab Abd-Allah Elkady Escalard Corvol Delorme Tattevin Bigaut Lorenz Hornuss Hosp Rieg Wagner Knier Lingor Winkler Sharifi-Razavi Moein SeyedAlinaghi JamaliMoghadamSiahkali Morassi Padovani Giunta Libri Beretta Ravaglia Foschi Calabresi Primiano Servidei Biagio Mercuri Liguori Pierantozzi Sarmati Boso Garazzino Mariotto Patrick Costache Pincherle Klok Meza Cabreira Valdoleiros Oliveira Kaimovsky Guekht Koh Fernández Díaz Barrios-López Guijarro-Castro Beltrán-Corbellini Martínez-Poles Diezma-Martín Morales-Casado García García Breville Coen Uginet Bernard-Valnet Du Pasquier Kaya Abdelnour Rice Morrison Defres Huda Enright Hassell D'Anna Benger Sztriha Raith Chinthapalli Nortley Paterson Chandratheva Werring Dervisevic Harkness Pinto Jillella Beach Gunasekaran Rocha Ferreira Da Silva Nalleballe Santoro Scullen Kahn Kim Thakur Jain Umapathi Nicholson Sejvar Hodel Tudur Smith Solomon
Study Outcome
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Statistics
Citations : Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533–4. doi: 10.1016/S1473-3099(20)30120-1Authors : 157
Identifiers
Doi : e0263595SSN : 1932-6203