Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

Wnuk, Marcin; Sawczyńska, Katarzyna; Kęsek, Tomasz; Wrona, Paweł; Chatys-Bogacka, Żaneta; Mazurkiewicz, Iwona; Drabik, Leszek; Jagiełła, Jeremiasz; Szaleniec, Joanna; Czepiel, Jacek; Pawliński, Łukasz; Bień, Artur Igor; Kania, Michał; Fiema, Mateusz; Zięba-Parkitny, Joanna; Hajek, Agnes; Ucieklak, Damian; Wilk, Magdalena; Pośpiech, Kamila; Lechowicz, Patrycja; Kasprzycki, Karol; Kopka, Marianna; Hohendorff, Jerzy; Katra, Barbara; Kostrzycka, Małgorzata; Adamczyk, Michalina; Surowiec, Paulina; Rybicka, Monika; Walczewska, Jolanta; Kamińska, Barbara; Piętak, Ewelina; Bryniarski, Paweł; Marona, Monika; Motyl, Maciej; Kępińska-Wnuk, Alicja; Włodarczyk, M.; Nowak, Klaudia; Gradek-Kwinta, Elżbieta; Czyzycki, Mateusz; Dwojak, Mateusz; Rzemińska, Agnieszka; Wężyk, Kamil; Koźmiński, Wojciech; Pułyk, Agnieszka; Garlicki, Aleksander; Grodzicki, Tomasz; Małecki, Maciej; Słowik, Agnieszka

doi:10.5603/pjnns.a2021.0039

Cited by 22 publications

(26 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The incidences of at least one new-onset neurological signs/symptoms in the context of COVID-19 infection were extremely wide-ranging, i.e., ~ 12 to ~ 85%. The wide extent of these percentages was based on retrospective and prospective studies from various countries: Austria (Zifko et al 2021); China (Mao et al 2020;Xiong et al 2020) Egypt (Khedr et al 2021); Iran (Amanat et al 2021;Ghaffari et al 2021); Italy (Benussi et al 2020;Rifino et al 2021;Travi et al 2021); France (Kremer et al 2020); Germany (Fleischer et al 2021); Mexico (Flores-Silva et al 2021); Pakistan (Iltaf et al 2020); Poland (Wnuk et al 2021); Portugal (Oliveira et al 2021); South Korea (Kim et al 2021);Spain (García-Azorín et al 2021a, b;García-Moncó et al 2020;García-Azorín et al 2021a, b;Romero-Sánchez et al 2020); Turkey (Karadaş et al 2020;Yuksel et al 2021); United States of America (Chachkhiani et al 2020;Eskandar et al 2021;Frontera et al 2021;Liotta et al 2020); multinational (Chou et al 2021). Systematic reviews with or without meta-analysis (Cagnazzo et al 2021;Chua et al 2020;Collantes et al 2021;Pinzon et al 2020;Romoli et al 2020;Tsai et al 2020;Vakili et al 2021) and narrative/ scoping reviews (Ahmed et al 2020;Maury et al 2021;Roy et al 2021...…”

Section: Discussionmentioning

confidence: 99%

COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study)

Espiritu

Anlacan

et al. 2021

J Neural Transm

View full text Add to dashboard Cite

Our study aimed to determine the effects of new-onset neurological symptoms (NNS) on clinically relevant outcomes in hospitalized patients with COVID-19 infection. We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines. We included a total of 10,881 patients with confirmed COVID-19 infection (2008 had NNS while 8873 did not have NNS). The adjusted hazard ratios (aHRs) for mortality among the mild and severe cases were significantly higher by 1.660 (95% CI 1.132–2.435) and by 1.352 (95% CI 1.042–1.752), respectively, in the NNS group compared to those in the non-NNS group. The aHRs for respiratory failure in the NNS group were significantly increased by 1.914 (95% CI 1.346–2.722), by 1.614 (95% CI 1.260–2.068), and by 1.234 (95% CI 1.089–1.398) among the mild, severe, and critical cases, respectively. The aHRs for ICU admission in the NNS group were still significantly higher by 1.973 (95% CI 1.457–2.673) and by 1.831 (95% CI 1.506–2.226) among the mild and severe cases, respectively. Patients who had NNS were not significantly associated with a longer duration of ventilator dependence (adjusted odds ratio (aOR) 0.954, 95% CI 0.772–1.179), longer ICU stay (aOR 0.983, 95% CI 0.772–1.252) and longer hospital admission (aOR 1.045, 95% CI 0.947–1.153). The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients. Registration and associated protocol publication: ClinicalTrials.gov website (NCT04386083); Espiritu AI, Sy MCC, Anlacan VMM, Jamora RDG. The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA study): a protocol study. BMJ Open. 2020;10:e040944.

show abstract

Section: Discussionmentioning

confidence: 99%

COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study)

Espiritu

Anlacan

et al. 2021

J Neural Transm

View full text Add to dashboard Cite

show abstract

“…The involvement of respiratory muscles can lead to myasthenic crisis, a life-threatening condition that requires intensive care and respiratory support [3]. On the other hand, fatigue and muscle weakness as well as respiratory failure are cardinal symptoms of Coronavirus disease 2019 (COVID-19) [4,5]. Therefore, it can be very challenging to distinguish between these two conditions as well as to diagnose MG exacerbation during a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [6].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 pandemic year in a sample of Polish myasthenia gravis patients: an observational study

Rzepiński¹,

Zawadka‐Kunikowska

2022

Neurol Neurochir Pol.

View full text Add to dashboard Cite

Aim of the study: Coronavirus disease 2019 (COVID-19) incidence, mortality, recovery and hospitalisation rates vary in different countries. This study aimed to present the clinical characteristics of a sample of unvaccinated Polish myasthenia gravis (MG) patients during the first year of the COVID-19 pandemic, taking into account the number of MG exacerbations, a detailed description of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection course, and the need to modify immunosuppressive therapies. Clinical rationale for the study:To assess the impact of the first COVID-19 pandemic year on MG course in a sample of unvaccinated patients. Materials and methods: A retrospective observational study involving 30 unvaccinated Polish MG patients consulted in a neurological outpatient clinic on 11-31 March, 2020 (baseline) and 11-31 March, 2021 (endpoint).Results: During the period of evaluation, exacerbation of MG requiring hospitalisation was reported in 11 patients. Among them, four were treated with intravenous immunoglobulin and another six required plasma exchange. In the study group, COVID-19 was identified in 10 patients. Of them, seven experienced a mild course of SARSCoV-2 infection with spontaneous recovery. In the remaining three patients, both MG exacerbation and SARS-CoV-2 infection were reported. These patients experienced MG exacerbation in the preceding month or concurrently with COVID-19 and were aged over 50 years. Due to the SARS-CoV-2 infection, they required antibiotic and oxygen therapy, and hospitalisation was necessary in the case of two obese patients. None of the patients died due to COVID-19, and nor did any require discontinuation of immunosuppressive therapies during the study period. In total, 12 patients in the study group experienced neither MG exacerbation nor SARS-CoV-2 infection. Conclusions:In the presented sample of Polish MG patients, favourable outcomes of COVID-19 were observed. Further studies are needed to evaluate the reliable course of COVID-19 taking into account international differences, the types of treatment applied, and the ratio of vaccinated to unvaccinated MG patients.

show abstract

“…Since the beginning of the COVID-19 pandemic, growing evidence has indicated that patients with SARS-CoV-2 may develop neurological symptoms (Tab. 1) [7,28]. It has been established that the major factors associated with the neurological complications of SARS-CoV-2 infection were firstly age over 60, and secondly a history of neurological conditions.…”

Section: Neurological Symptoms Of Covid-19mentioning

confidence: 99%

“…Anosmia and ageusia were reported in 21.5% and 27% of patients, respectively. Moreover, analysis of a possible association of neurological symptoms with inhospital mortality revealed that a decreased level of consciousness and delirium were linked to a higher risk of death during hospitalisation [34].…”

Section: Neurological Symptoms Of Covid-19mentioning

confidence: 99%

Neuro-COVID-19: an insidious virus in action

Bratosiewicz-Wąsik

2022

Neurol Neurochir Pol.

View full text Add to dashboard Cite

Introduction:The punishing effect of the pandemic outbreak of the disease termed COVID-19 (coronavirus disease-19) caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) impelled the author to gather the facts about the nature of this new pathogen. The aim of this paper was to discuss the mechanisms involved in the pathogenesis of neurological complications during the course of COVID-19. State of the art:Neurological symptoms, such as impairment of taste or smell, headache, nausea and/or altered consciousness, are commonly described in COVID-19 patients, although there are emerging clinical reports of more serious conditions such as acute cerebrovascular accidents, encephalitis and demyelinating disease. Whether these manifestations are the direct consequence of viral invasion of the central nervous system, or are caused by indirect mechanisms, is yet to be established. Studies to date have indicated that neurological lesions found in the brains of COVID-19 patients are a combination of direct cytopathic effects caused by SARS-CoV-2 replication and indirect effects due to hypoxia, excessive cytokine reaction, impaired immune response, and cerebrovascular injury induced by viral infection. Studies are still pending into possible routes of SARS--CoV-2 neuroinvasion encompassing the haematopoietic pathway via the blood-brain barrier and retrograde axonal transport through the cranial nerves. Clinical implications: A thorough understanding of SARS-CoV-2 involvement in neurological complications is still lacking. However, our knowledge about SARS-CoV-2 virulence is rapidly expanding, and that has inclined the author to prepare this comprehensive review in the hope that it will improve understanding about the molecular mechanisms underlying neurological abnormalities associated with COVID-19. Future directions:A future detailed study should explore the diagnostics and disease mechanisms so as to enable the development of better therapeutic strategies to reduce the severity of COVID-19 neurological complications.

show abstract

Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

Cited by 22 publications

References 27 publications

COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study)

COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study)

COVID-19 pandemic year in a sample of Polish myasthenia gravis patients: an observational study

Neuro-COVID-19: an insidious virus in action

Contact Info

Product

Resources

About