A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications

Abstract

Background Little is known regarding long-term outcomes of patients hospitalized with COVID-19. Methods We conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep. Results Of 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N = 196 neurological patients and N = 186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 1.98, 95%CI 1.23–3.48, P = 0.02), worse ADLs (aOR 0.38, 95%CI 0.29–0.74, P = 0.01) and were less likely to return to work than controls (41% versus 64%, P = 0.04). Cognitive and Neuro-QOL metrics were similar between groups. Conclusions Abnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.

Serum neurofilament light protein correlates with unfavorable clinical outcomes in hospitalized patients with COVID-19

“…Nevertheless, our understanding of the long-term implications is limited. It has been shown that patients previously hospitalized with COVID-19 display a wide array of neurological symptoms months after discharge (10,12,37) but few studies have systematically followed patients over time, likely because of the inherent difficulties in doing so. However, based on our present data, we posit that longitudinal measurements of serum NFL would provide an efficient means to identify and quantify neurological injury in hospitalized patients with COVID-19.…”

“…Although common symptoms of coronavirus disease 2019 (COVID-19) include fever, cough, fatigue and shortness of breath, the manifestations of COVID-19 can vary widely. For example, some patients can develop pneumonia, acute respiratory distress syndrome, myocardial injury, arrhythmias and/or multi-organ failure (2), and it is increasingly recognized that SARS-CoV-2 can cause neurologic signs (3)(4)(5)(6)(7)(8)(9)(10). Indeed, clinical studies observed neuropsychiatric manifestations in up to 70% of patients with COVID-19, including young adults and patients in whom respiratory symptoms have long resolved (10)(11)(12).…”

“…For example, some patients can develop pneumonia, acute respiratory distress syndrome, myocardial injury, arrhythmias and/or multi-organ failure (2), and it is increasingly recognized that SARS-CoV-2 can cause neurologic signs (3)(4)(5)(6)(7)(8)(9)(10). Indeed, clinical studies observed neuropsychiatric manifestations in up to 70% of patients with COVID-19, including young adults and patients in whom respiratory symptoms have long resolved (10)(11)(12). Brain imaging studies detected diverse lesions including perfusion abnormalities with or without acute infarctions, cerebral venous thrombosis, macro-and micro-hemorrhages, multifocal white matter and basal ganglia lesions, meningeal enhancement, central pontine myelinolysis, posterior reversible encephalopathy syndrome and neuritis (13)(14)(15)(16).…”

Letter to the editor regarding “Coexistence of neurological diseases with Covid-19 pneumonia during the pandemic period”

“…Frontera et al [6] conducted a prospective study where they followed 382 patients who developed neurological complications during the acute phase of COVID-19 for 6 months, observing that 91% at least persisted with 1 abnormal outcome, 56% had limitations in performing activities of daily living, 50% had cognitive impairment, 47% were unable to return to work, and 62% scored worse than average on ≥ 1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%) [6] . The authors concluded that those who present any type of neurological complication during the acute phase of COVID-19 have a worse prognosis at 6 months compared to those who do not.…”

“…The authors concluded that those who present any type of neurological complication during the acute phase of COVID-19 have a worse prognosis at 6 months compared to those who do not. However, it is observable that almost all of those who present neurological manifestations persist in the long term [6] . Therefore, it is expected that the prognosis in those with a history of neuropsychiatric disorders will be worse [4] .…”