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. 2021 Dec;28(12):3925-3937.
doi: 10.1111/ene.15072. Epub 2021 Sep 3.

Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS)

Nina N Kleineberg  1   2 , Samuel Knauss  3   4 , Eileen Gülke  5 , Hans O Pinnschmidt  6 , Carolin E M Jakob  7   8 , Paul Lingor  9 , Kerstin Hellwig  10 , Achim Berthele  9 , Günter Höglinger  11   12 , Gereon R Fink  1   2 , Matthias Endres  3   13   14   15   16 , Christian Gerloff  5 , Christine Klein  17 , Melanie Stecher  7   8 , Annika Y Classen  7   8 , Siegbert Rieg  18 , Stefan Borgmann  19 , Frank Hanses  20   21 , Maria M Rüthrich  22   23 , Martin Hower  24 , Lukas Tometten  7 , Martina Haselberger  25 , Christiane Piepel  26 , Uta Merle  27 , Sebastian Dolff  28 , Christian Degenhardt  29 , Björn-Erik O Jensen  30 , Maria J G T Vehreschild  31 , Johanna Erber  32 , Christiana Franke  3 , Clemens Warnke  1 ; LEOSS Study Group
Affiliations

Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS)

Nina N Kleineberg et al. Eur J Neurol. 2021 Dec.

Abstract

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.

Keywords: COVID-19; SARS-CoV-2; neurological manifestations.

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Conflict of interest statement

All authors report no disclosures relevant to the manuscript.

Figures

FIGURE 1
FIGURE 1
Definition of disease phases. GOT, glutamate‐oxaloacetate transaminase; GPT, glutamate pyruvate transaminase; qSOFA, quick sepsis‐related organ failure assessment score
FIGURE 2
FIGURE 2
Component loadings of variables for Dimensions 1 and 2, extracted by categorical principal component analysis
See this image and copyright information in PMC

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