Impact of new-onset and preexisting neurological disorders in COVID-19 patients

Abstract

Background and purpose: Coronavirus disease (COVID-19) is still considered a global pandemic. The prognosis of COVID-19 patients varies greatly. We aimed to assess the impact of preexisting, chronic neurological diseases (CNDs) and new-onset acute neurological complications (ANCs) on the disease course, its complications, and outcomes.

Methods: We conducted a monocentric retrospective analysis from all hospitalized COVID-19 patients between May 1, 2020 and January 31, 2021. Employing multivariable logistic regression models, we explored the association of CNDs and ANCs separately with hospital mortality and functional outcome.

Results: A total of 250 among 709 patients with COVID-19 had CNDs. We found a 2.0 times higher chance of death (95% confidence interval [CI]: 1.37-2.92) for CND patients than for non-CND patients. The chance for an unfavorable functional outcome (modified Rankin Scale > 3 at discharge) was 1.67 times higher in patients with CNDs than those without (95% CI: 1.07-2.59). Furthermore, 117 of all patients had 135 ANCs in total. We observed a 1.86 times higher chance to die (95% CI: 1.18-2.93) for patients with ANCs than without. The chance for a worse functional outcome was 3.6-fold higher in ANC patients than without (95% CI: 2.22-6.01). Patients with CNDs had 1.73 times higher odds for developing ANCs (95% CI: 0.97-3.08).

Conclusion: Preexisting neurologic disorders or ANCs in COVID-19 patients were associated with higher mortality and poorer functional outcome at discharge. Furthermore, development of acute neurologic complications was more frequent in patients with preexisting neurologic disease. Early neurological evaluation appears to be an important prognostic factor in COVID-19 patients.

Keywords: COVID-19; SARS-CoV2; acute neurological complications; hospital mortality; neurological diseases.

FIGURE 1

Alluvial plots demonstrating mRS at hospital admission and discharge in patients divided into two groups: CND and non‐CND. (a) Development of mRS in CND patients. (b) Development of mRS in non‐CND patients. Alluvial plots of the mRS classes for patients with preexisting neurological disorders (CND; total number: [a] 250 and [b] 459). Left: mRS classes 0–5 and their counts at the time of hospital admission. Right: mRS classes 0–6 and their counts at the time of hospital discharge. The plot reveals the number of patients crossing from one class to another after hospitalization. Dark shaded stream fields depict worse mRS status at admission time. Of all patients with mRS 0–3 (a: n = 140, b: n = 436) at admission time 42.9% (a) respectively 22.5% (b) developed an mRS 4–6. Note that box height of low group counts on both sides does not reflect the group size. All mRS groups with count of at most 32 have increased box heights. The heights are increased for illustrative reasons.

FIGURE 2

Regression model for survival with CND as predictor. Forest plot for the results of a multiple regression with survival as response. Left: List of the considered predictors variables. Middle: Odds ratio (OR) of the corresponding category of a predictor for death; opposite categories are reference category (95% confidence intervals [CIs] for the OR are presented in brackets). For age, the OR represents the change for survival in a 1‐year difference. Right: OR and 95% CI displayed, where the indifference value of 1.0 is highlighted; the axis is on a log scale. Statistical significance (p < .05) is marked with an asterisk. The corresponding p‐values of the regression for the predictors are presented in the supplements. DM, diabetes mellitus; RI, renal insufficiency Stadium I–III and IV–V; COPD, chronic obstructive pulmonary disease (Gold A + B and C + D state of disease); CAD, coronary artery disease; CND, chronic neurological disorder.

FIGURE 3

Alluvial plots demonstrating mRS at hospital admission and discharge in patients divided into two groups: ANC and non‐ANC. (a) Development of mRS in ANC patients. (b) Development of mRS in non‐ANC patients. Alluvial plots of the mRS classes for patients with acute neurological complications (ANC; total number: [a] 117 and [b] 592). Left: mRS classes 0–5 and their counts at the time of hospital admission. Right: mRS classes 0–6 and their counts at the time of hospital discharge. The plot reveals the number of patients crossing from one class to another after hospitalization. Dark shaded stream fields depict worse mRS status at admission time. Of all patients with mRS 0–3 (a: n = 95, b: n = 481) at admission time 53.7% (a) respectively 22.3% (b) developed an mRS 4–6. Note that box height of low group counts on both sides does not reflect the group size. All mRS groups with count of at most 8 (a) respectively 75 (b) have increased box heights. The heights are increased for illustrative reasons.

FIGURE 4

Regression model for survival with ANC as predictor. Forest plot for the results of a multiple regression with survival as response. Left: List of the considered predictors variables. Middle: Odds ratio (OR) of the corresponding category of a predictor for death; opposite categories are reference category (95% confidence intervals [CIs] for the OR are presented in brackets). For age, the OR represents the change for survival in a 1‐year difference. Right: OR and 95% CI displayed, where the indifference value of 1.0 is highlighted; the axis is on a log scale. Statistical significance (p < .05) is marked with an asterisk (*). The corresponding p‐values of the regression for the predictors are presented in the supplements. DM, diabetes mellitus; RI, renal insufficiency Stadium I–III and IV–V; COPD, chronic obstructive pulmonary disease (Gold A+B and C+D state of disease); CAD, coronary artery disease; ANC, acute neurological complication.