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Multicenter Study
. 2023 Oct;64(10):2725-2737.
doi: 10.1111/epi.17715. Epub 2023 Jul 28.

In-hospital outcomes in patients with and without epilepsy diagnosed with COVID-19-A cohort study

Claire Ufongene  1 , Grace Van Hyfte  2 , Parul Agarwal  2   3 , Leah J Blank  2   3 , Jonathan Goldstein  1 , Brian Mathew  3 , Jung-Yi Lin  2 , Allison Navis  3 , Louise McCarthy  3 , Kapil Gururangan  3 , Veronica Peschansky  3   4 , Churl-Su Kwon  4   5 , Ariella Cohen  1 , Andy Ho Wing Chan  3 , Mandip Dhamoon  3 , Pojen Deng  3 , Eveline M Gutzwiller  3 , Qing Hao  3 , Celestine He  1 , Wilson D Heredia Nunez  3 , Britany Klenofsky  3 , Hernan Nicolas Lemus  6 , Lara Marcuse  3 , Mallory Roberts  3 , Emily M Schorr  7 , Anuradha Singh  3 , Gabriela Tantillo  8 , James Young  3 , Priti Balchandani  9 , Joanne Festa  3   10 , Georges Naasan  3   10 , Alexander Charney  11   12 , Girish Nadkarni  13 , Nathalie Jetté  2   3   14
Affiliations
Multicenter Study

In-hospital outcomes in patients with and without epilepsy diagnosed with COVID-19-A cohort study

Claire Ufongene et al. Epilepsia. 2023 Oct.

Abstract

Objectives: Coronavirus disease 2019 (COVID-19) is associated with mortality in persons with comorbidities. The aim of this study was to evaluate in-hospital outcomes in patients with COVID-19 with and without epilepsy.

Methods: We conducted a retrospective study of patients with COVID-19 admitted to a multicenter health system between March 15, 2020, and May 17, 2021. Patients with epilepsy were identified using a validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM case definition. Logistic regression models and Kaplan-Meier analyses were conducted for mortality and non-routine discharges (i.e., not discharged home). An ordinary least-squares regression model was fitted for length of stay (LOS).

Results: We identified 9833 people with COVID-19 including 334 with epilepsy. On univariate analysis, people with epilepsy had significantly higher ventilator use (37.70% vs 14.30%, p < .001), intensive care unit (ICU) admissions (39.20% vs 17.70%, p < .001) mortality rate (29.60% vs 19.90%, p < .001), and longer LOS (12 days vs 7 days, p < .001). and fewer were discharged home (29.64% vs 57.37%, p < .001). On multivariate analysis, only non-routine discharge (adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 2.00-3.70; p < .001) and LOS (32.50% longer, 95% CI 22.20%-43.60%; p < .001) were significantly different. Factors associated with higher odds of mortality in epilepsy were older age (aOR 1.05, 95% CI 1.03-1.08; p < .001), ventilator support (aOR 7.18, 95% CI 3.12-16.48; p < .001), and higher Charlson comorbidity index (CCI) (aOR 1.18, 95% CI 1.04-1.34; p = .010). In epilepsy, admissions between August and December 2020 or January and May 2021 were associated with a lower odds of non-routine discharge and decreased LOS compared to admissions between March and July 2020, but this difference was not statistically significant.

Significance: People with COVID-19 who had epilepsy had a higher odds of non-routine discharge and longer LOS but not higher mortality. Older age (≥65), ventilator use, and higher CCI were associated with COVID-19 mortality in epilepsy. This suggests that older adults with epilepsy and multimorbidity are more vulnerable than those without and should be monitored closely in the setting of COVID-19.

Keywords: COVID-19; comorbidity; hospital outcomes; neurological; seizure.

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Conflict of interest statement

Nathalie Jetté has received grant funding paid to her institution from NINDS (NIH U24NS107201, NIH IU54NS100064, NIH U24NS113849), the American Epilepsy Society and the NORSE Institute during the study period. She receives an honorarium for her work as an Associate Editor of Epilepsia. Churl-Su Kwon has received support from the American Epilepsy Society. Leah J. Blank has received research support from the American Epilepsy Society, Epilepsy Foundation, NORSE Institute, the Mount Sinai Claude D Pepper Older American Independence Center (5P30AG028741–11), and the Icahn School of Medicine Department of Neurology. Parul Agarwal receives grant funding paid to her institution for grants unrelated to this work from NIH HD100544, NIH PD22-01299, and SU2C 6209. She receives an honorarium for her work as an Assistant Editor of Statistics of Anesthesia & Analgesia. Emily M. Schorr. has received fellowship funding from Biogen. Priti Balchandani has received grant funding paid to her institution from NCI and NINDS (R01CA202911, R00NS070821, R21NS122389). Kapil Gururangan serves as a scientific advisor to Ceribell Inc., receives consulting fees for research contributions unrelated to this work, and owns stock options in Ceribell Inc. In addition, Kapil Gururangan has received grant funding paid to his institution from NINDS (R25NS079102) and the Leon Levy Foundation and serves as a review editor for Frontiers in Neurology – Epilepsy. Georges Naasan has received an honorarium for advisory work from Genentech. The remaining authors report no disclosures. James Young receives research support from Monteris (for unrelated research) as well as grant support from NINDS R25 (NS8440304) and the Leon Levy Foundation.

References

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