Six-month Neurological and Psychiatric Outcomes in 236,379 Survivors of COVID-19

Abstract

BackgroundNeurological and psychiatric sequelae of COVID-19 have been reported, but there are limited data on incidence rates and relative risks.MethodsUsing retrospective cohort studies and time-to-event analysis, we estimated the incidence of ICD-10 diagnoses in the 6 months after a confirmed diagnosis of COVID-19: intracranial haemorrhage; ischaemic stroke; Parkinsonism; Guillain-Barré syndrome; nerve/nerve root/plexus disorders; myoneural/muscle disease; encephalitis; dementia; mood, anxiety, and psychotic disorders; substance misuse; and insomnia. Data were obtained from the TriNetX electronic health records network (over 81 million patients). We compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory infections using a Cox model. We investigated the effect on incidence estimates of COVID-19 severity, as proxied by hospitalization and encephalopathy (including delirium and related disorders).Findings236,379 patients survived a confirmed diagnosis of COVID-19. Among them, the estimated incidence of neurological or psychiatric sequelae at 6 months was 33.6%, with 12.8% receiving their first such diagnosis. Most diagnostic categories were commoner after COVID-19 than after influenza or other respiratory infections (hazard ratios from 1.21 to 5.28), including stroke, intracranial haemorrhage, dementia, and psychotic disorders. Findings were equivocal for Parkinsonism and Guillain-Barré syndrome. Amongst COVID-19 cases, incidences and hazard ratios for most disorders were higher in patients who had been hospitalized, and markedly so in those who had experienced encephalopathy. Results were robust to sensitivity analyses, including comparisons against an additional four index health events.InterpretationThe study provides evidence for substantial neurological and psychiatric morbidity following COVID-19 infection. Risks were greatest in, but not limited to, those who had severe COVID-19. The information can help in service planning and identification of research priorities.FundingNational Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre.

Neurological and Head/Eyes/Ears/Nose/Throat Manifestations of COVID-19: A Systematic Review and Meta-Analysis

“…51 This was followed recently by another TriNetX analysis, this time of 236,379 patientsincluding 190,077 patients who were not hospitalized and 8,945 patients who needed critical carewhich is the largest dataset to date. 52 This study was limited by its retrospective design and reliance on electronic medical record codes. However, the study had a large sample size, and included both hospitalized and non-hospitalized patients.…”

“…127 Similar findings were reported in a recent large analysis of the TriNetX platform, with an estimated 6month incidence of GBS of 0.08% in patients with COVID-19, with a hazard ratio of 2.06 (95%CI 1.43-2.96) versus patients with other respiratory tract infections. 52 Two retrospective cohort studies on the frequency of GBS met our inclusion criteria for pooled analysis. These studies had a moderate risk of bias on most domains (Supplementary Figure 2D).…”

Neurosciences and Neuro post-COVID-19

“…In the study by Taquet et al (2021) out of 236, 370 patients at 6 months, the global incidence of neurological and psychiatric pathologies was 33% of those infected with symptoms, in those who were admitted to intensive care units the incidence was 46% and in those who had encephalitis 62%. these authors showed a higher frequency of ACV, nerve, nerve root or plexus disorder, myoneural or muscle disease, dementia, mood, anxiety, or psychotic disorder.…”

What neurological and psychiatric effects does COVID-19 have on its survivors?

“…In contrast, the cases discussed by Taquet and colleagues may have presented distinct characteristics. Therefore, outcomes for this population should not be considered generalizable to all delirium patients [2]. Last, such a study design may only depict associations; attempts to classify pathways and measure causality will require more detailed study designs [2].…”

“…Alexios-Fotios A. Mentis 1,2 Background Since the COVID-19 pandemic began, there has been a steadily increasing interest on the COVID-19 infection's neurological and psychiatric sequelae, such as dementia and mood/anxiety disorders [1]. However, the majority of studies reporting on COVID-19−related neurological complications are generally confined to small series of patients and to small numbers of hospitals and are limited to locations and specialization; thus, the neuropsychiatric consequences of COVID-19 are not evaluated across a broader spectrum of population and independent geographic settings [2][3][4]. Hence, larger, more robust, and long-term data are essential to define and critically evaluate the effects of the COVID-19 pandemic on neurological and psychiatric disorders.…”