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Multicenter Study
. 2023 Jul 31;18(7):e0285349.
doi: 10.1371/journal.pone.0285349. eCollection 2023.

Clinical features and outcomes of hospitalised patients with COVID-19 and Parkinsonian disorders: A multicentre UK-based study

Lexy Sorrell  1 , Valentina Leta  2   3 , Anton Barnett  1 , Kara Stevens  4 , Angela King  1 , Jemma Inches  1   5 , Christopher Kobylecki  6   7 , Richard Walker  8   9 , K Ray Chaudhuri  2   3 , Hannah Martin  10 , Jane Rideout  11 , J Robert Sneyd  11 , Sarah Campbell  1 , Camille Carroll  1   5   12 ; COVID-19 PD UK study team
Affiliations
Multicenter Study

Clinical features and outcomes of hospitalised patients with COVID-19 and Parkinsonian disorders: A multicentre UK-based study

Lexy Sorrell et al. PLoS One. .

Abstract

Background: Parkinson's disease has been identified as a risk factor for severe Coronavirus disease 2019 (COVID-19) outcomes. However, whether the significant high risk of death from COVID-19 in people with Parkinson's disease is specific to the disease itself or driven by other concomitant and known risk factors such as comorbidities, age, and frailty remains unclear.

Objective: To investigate clinical profiles and outcomes of people with Parkinson's disease and atypical parkinsonian syndromes who tested positive for COVID-19 in the hospital setting in a multicentre UK-based study.

Methods: A retrospective cohort study of Parkinson's disease patients with a positive SARS-CoV-2 test admitted to hospital between February 2020 and July 2021. An online survey was used to collect data from clinical care records, recording patient, Parkinson's disease and COVID-19 characteristics. Associations with time-to-mortality and severe outcomes were analysed using either the Cox proportional hazards model or logistic regression models, as appropriate.

Results: Data from 552 admissions were collected: 365 (66%) male; median (inter-quartile range) age 80 (74-85) years. The 34-day all-cause mortality rate was 38.4%; male sex, increased age and frailty, Parkinson's dementia syndrome, requirement for respiratory support and no vaccination were associated with increased mortality risk. Community-acquired COVID-19 and co-morbid chronic neurological disorder were associated with increased odds of requiring respiratory support. Hospital-acquired COVID-19 and delirium were associated with requiring an increase in care level post-discharge.

Conclusions: This first, multicentre, UK-based study on people with Parkinson's disease or atypical parkinsonian syndromes, hospitalised with COVID-19, adds and expands previous findings on clinical profiles and outcomes in this population.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. COVID-19 PD UK participants compared to UK daily hospital admissions.
Positive COVID-19 cases captured in the COVID-19 PD UK study (red bar chart, left y-axis) by month, overlaid by UK daily COVID-19 hospital admissions [30] (blue line graph, right y-axis). Grey regions reflect COVID-19 wave one (23/03/2020–30/05/2020) and wave two (07/09/2020–22/05/2021) in the UK.
Fig 2
Fig 2. Clinical features of Parkinson’s disease.
Clinical features of Parkinson’s as a proportion by diagnosis of Parkinson’s disease. X-axis: proportion of feature within diagnosis. Abbreviations: Parkinson’s disease (PD), Parkinson’s dementia syndrome (PDD/DLB) and atypical parkinsonian syndrome (APS).
Fig 3
Fig 3. Symptoms of COVID-19.
Frequency of altered mental state and classic COVID-19 or respiratory symptoms by where COVID-19 was acquired. A: The frequency of community acquired COVID-19 patients (total n = 385) by symptoms of altered mental state, classic COVID-19 or other respiratory symptoms during admission). B: The frequency of hospital acquired COVID-19 patients (total n = 167) with the symptoms of altered mental state and classic COVID-19 or respiratory symptoms (mild symptoms or respiratory support) associated with their COVID-19 infection.
Fig 4
Fig 4. Time to discharge or death.
Density plot of time to discharge or death from first positive SARS-CoV-2 test by place of COVID-19 acquisition (community or hospital). Two patients that remained in hospital following the study period have been omitted.
Fig 5
Fig 5. Forest plot of the multivariable Cox proportional hazards model of mortality within 34-days of a COVID-19 positive test.
Abbreviations: confidence interval (CI).
Fig 6
Fig 6. Forest plot of the multivariable logistic regression model of the requirement for respiratory support.
Abbreviations: confidence interval (CI).
Fig 7
Fig 7. Forest plot of the multivariable logistic regression model of an increase in care post-discharge for patients admitted from their own home.
Delirium is considered as delirium associated with COVID-19 infection. Abbreviations: confidence interval (CI).
See this image and copyright information in PMC

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