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. 2021 Jul 15:426:117486.
doi: 10.1016/j.jns.2021.117486. Epub 2021 May 12.

A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications

Jennifer A Frontera  1 , Dixon Yang  2 , Ariane Lewis  2 , Palak Patel  2 , Chaitanya Medicherla  2 , Vito Arena  2 , Taolin Fang  2 , Andres Andino  2 , Thomas Snyder  2 , Maya Madhavan  2 , Daniel Gratch  2 , Benjamin Fuchs  2 , Alexa Dessy  2 , Melanie Canizares  2 , Ruben Jauregui  2 , Betsy Thomas  2 , Kristie Bauman  2 , Anlys Olivera  2 , Dhristie Bhagat  2 , Michael Sonson  2 , George Park  2 , Rebecca Stainman  2 , Brian Sunwoo  2 , Daniel Talmasov  2 , Michael Tamimi  2 , Yingrong Zhu  2 , Jonathan Rosenthal  2 , Levi Dygert  2 , Milan Ristic  2 , Haruki Ishii  2 , Eduard Valdes  2 , Mirza Omari  2 , Lindsey Gurin  2 , Joshua Huang  2 , Barry M Czeisler  2 , D Ethan Kahn  2 , Ting Zhou  2 , Jessica Lin  2 , Aaron S Lord  2 , Kara Melmed  2 , Sharon Meropol  2 , Andrea B Troxel  2 , Eva Petkova  2 , Thomas Wisniewski  2 , Laura Balcer  2 , Chris Morrison  2 , Shadi Yaghi  2 , Steven Galetta  2
Affiliations

A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications

Jennifer A Frontera et al. J Neurol Sci. .

Abstract

Background: Little is known regarding long-term outcomes of patients hospitalized with COVID-19.

Methods: We conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep.

Results: Of 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N = 196 neurological patients and N = 186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 1.98, 95%CI 1.23-3.48, P = 0.02), worse ADLs (aOR 0.38, 95%CI 0.29-0.74, P = 0.01) and were less likely to return to work than controls (41% versus 64%, P = 0.04). Cognitive and Neuro-QOL metrics were similar between groups.

Conclusions: Abnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.

Keywords: Anxiety; Brain; COVID-19; Cognitive; Depression; Fatigue; Function; Long-COVID; Long-hauler; Neurologic; Outcomes; Post-COVID syndrome; Post-acute sequelae of COVID; Quality of life; Readmission; SARS-CoV-2; Sleep.

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Figures

Fig. 1
Fig. 1
Flow chart of case and control inclusion and exclusion.
Fig. 2
Fig. 2
Ordinal logistic regression analysis of 6-month modified Rankin scores among patients with and without neurological disorders during hospitalization for COVID-19. (Adjusted odds ratio OR 1.98, 95% confidence interval 1.23–3.48, P = 0.02).
See this image and copyright information in PMC

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