Long-term outcomes of hospitalized patients with SARS-CoV-2/COVID-19 with and without neurological involvement: 3-year follow-up assessment

• DOI: 10.1371/journal.pmed.1004263
• Publication Date: 2024-04-04T17:21:56Z
• Authors: Anna Eligulashvili; Moshe Gordon; Jimmy S. Lee; Jeylin Lee; Shiv Mehrotra-Varma; Jai Mehrotra-Varma; Kevin Hsu; Imanyah Hilliard; Kristen Lee; Arleen Li; Muhammed Amir Ess...; Judy Yee; David J. Altschul; Emad Eskandar; Mark F. Mehler; Tim Q. Duong
• Keywords: Stroke; Dysautonomia

Background Acute neurological manifestation is a common complication of acute Coronavirus Disease 2019 (COVID-19) disease. This retrospective cohort study investigated the 3-year outcomes patients with and without significant manifestations during initial COVID-19 hospitalization. Methods findings Patients hospitalized for Severe Respiratory Syndrome 2 (SARS-CoV-2) infection between 03/01/2020 4/16/2020 in Montefiore Health System Bronx, an epicenter early pandemic, were included. Follow-up data was captured up to 01/23/2023 (3 years post-COVID-19). consisted 414 1,199 propensity-matched (for age severity score) manifestations. Neurological involvement phase included stroke, new or recrudescent seizures, anatomic brain lesions, presence altered mentation evidence impaired cognition arousal, neuro-COVID-19 complex (headache, anosmia, ageusia, chemesthesis, vertigo, presyncope, paresthesias, cranial nerve abnormalities, ataxia, dysautonomia, skeletal muscle injury normal orientation arousal signs). There no group differences female sex composition (44.93% versus 48.21%, p = 0.249), ICU IMV status, white, not Hispanic (6.52% 7.84%, 0.380), (33.57% 38.20%, 0.093), except black non-Hispanic (42.51% 36.03%, 0.019). Primary mortality, heart attack, major adverse cardiovascular events (MACE), reinfection, hospital readmission post-discharge. Secondary neuroimaging (hemorrhage, active prior mass effect, microhemorrhages, white matter changes, microvascular disease (MVD), volume loss). More discharged rehabilitation (10.39% 3.34%, < 0.001) skilled nursing facilities (35.75% 25.35%, fewer home (50.24% 66.64%, than matched controls. Incidence any reason (65.70% 60.72%, 0.036), stroke (6.28% 2.34%, 0.001), MACE (20.53% 16.51%, 0.032) higher Per Kaplan–Meier univariate survival curve analysis, such more likely die post-discharge compared controls (hazard ratio: 2.346, (95% confidence interval (CI) [1.586, 3.470]; 0.001)). Across both cohorts, causes death (13.79% neurological, 15.38% control), sepsis (8.63%, 17.58%), influenza pneumonia (13.79%, 9.89%), (10.34%, 7.69%), respiratory distress syndrome (ARDS) 6.59%). Factors associated mortality after leaving involved (odds ratio (OR): 1.802 CI [1.237, 2.608]; 0.002)), discharge disposition (OR: 1.508 [1.276, 1.775]; 0.001)), congestive failure 2.281 [1.429, 3.593]; score 1.177 [1.062, 1.304]; older 1.027 [1.010, 1.044]; 0.002)). radiological findings, that showed significantly age-adjusted loss ( 0.045) The study’s patient limited infected first wave when hospitals overburdened, vaccines yet available, treatments limited. Patient profiles might differ interrogating subsequent waves. Conclusions had worse long-term These raise awareness need closer monitoring timely interventions manifestations, as their course involving enhanced morbidity mortality.