A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

Jennifer A Frontera¹, Sakinah Sabadia², Rebecca Lalchan², Taolin Fang², Brent Flusty², Patricio Millar-Vernetti², Thomas Snyder², Stephen Berger², Dixon Yang², Andre Granger², Nicole Morgan², Palak Patel², Josef Gutman², Kara Melmed², Shashank Agarwal², Matthew Bokhari², Andres Andino², Eduard Valdes², Mirza Omari², Alexandra Kvernland², Kaitlyn Lillemoe², Sherry H-Y Chou², Molly McNett², Raimund Helbok², Shraddha Mainali², Ericka L Fink², Courtney Robertson², Michelle Schober², Jose I Suarez², Wendy Ziai², David Menon², Daniel Friedman², David Friedman², Manisha Holmes², Joshua Huang², Sujata Thawani², Jonathan Howard², Nada Abou-Fayssal², Penina Krieger², Ariane Lewis², Aaron S Lord², Ting Zhou², D Ethan Kahn², Barry M Czeisler², Jose Torres², Shadi Yaghi², Koto Ishida², Erica Scher², Adam de Havenon², Dimitris Placantonakis², Mengling Liu², Thomas Wisniewski², Andrea B Troxel², Laura Balcer², Steven Galetta²

Affiliations

¹ From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK. jennifer.frontera@nyulangone.org.
² From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK.

PMID: 33020166
PMCID: PMC7905791
DOI: 10.1212/WNL.0000000000010979

Observational Study

A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

Jennifer A Frontera et al. Neurology. 2021.

. 2021 Jan 26;96(4):e575-e586.

doi: 10.1212/WNL.0000000000010979. Epub 2020 Oct 5.

Authors

Affiliations

¹ From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK. jennifer.frontera@nyulangone.org.
² From the New York University Grossman School of Medicine (J.A.F., S.S., R.L., T.F., B.F., P.M.-V., T.S., S.B., D.Y., A.G., N.M., P.P., J.G., K.M., S.A., M.B., A.A., E.V., M.O., A.K., K.L., Daniel Friedman, David Friedman, M.H., J.H., S.T., J.H., N.A.-F., P.K., A.L., A.S.L., T.Z., D.E.K., B.M.C., J.T., S.Y., K.I., E.S., D.P., M.L., T.W., A.B.T., L.B., S.G.), New YorkUniversity of Pittsburgh School of Medicine (S.H.-Y.C., E.L.F.), PAThe Ohio State University (M.M., S.M.), ColumbusMedical University of Innsbruck (R.H.), AustriaThe Johns Hopkins University School of Medicine (C.R., J.I.S., W.Z.), Baltimore, MDUniversity of Utah School of Medicine (M.S., A.d.H.), Salt Lake CityUniversity of Cambridge (D.M.), UK.

PMID: 33020166
PMCID: PMC7905791
DOI: 10.1212/WNL.0000000000010979

Abstract

Objective: To determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.

Methods: We conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.

Results: Of 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001).

Conclusions: Neurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.

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Figures

**Figure. Flowchart of Patient Inclusion and Exclusion**
SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

See this image and copyright information in PMC

Comment in

The Impact of COVID-19 on Developing Neurologic Disorders.
Tekiela P, Majersik JJ. Tekiela P, et al. Neurology. 2021 Jan 26;96(4):e647-e649. doi: 10.1212/WNL.0000000000011348. Neurology. 2021. PMID: 33495396 No abstract available.
Editor's Note: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.
Ganesh A. Ganesh A. Neurology. 2021 Mar 16;96(11):548. doi: 10.1212/WNL.0000000000011604. Neurology. 2021. PMID: 33723023 No abstract available.
Reader Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.
Kumar A, Lall N, Singh VK. Kumar A, et al. Neurology. 2021 Mar 16;96(11):549. doi: 10.1212/WNL.0000000000011614. Neurology. 2021. PMID: 33723024 No abstract available.
Author Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.
Frontera JA, Balcer L, Galetta S. Frontera JA, et al. Neurology. 2021 Mar 16;96(11):549-550. doi: 10.1212/WNL.0000000000011609. Neurology. 2021. PMID: 33723025 No abstract available.
Reader Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.
Liotta EM, Batra A, Koralnik IJ. Liotta EM, et al. Neurology. 2021 Mar 16;96(11):550. doi: 10.1212/WNL.0000000000011613. Neurology. 2021. PMID: 33723026 No abstract available.
Author Response: A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City.
Frontera JA, Lewis A, Balcer L, Galetta S. Frontera JA, et al. Neurology. 2021 Mar 16;96(11):551. doi: 10.1212/WNL.0000000000011611. Neurology. 2021. PMID: 33723027 No abstract available.

References

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1. Mao L, Jin H, Wang M, et al. . Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683–690. - PMC - PubMed
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A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

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A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

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