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Risk Factors for New Neurological Diagnoses in Hospitalized COVID-19 Patients: A Case-Control Study in New York City

28 Pages Posted: 6 Jan 2022

See all articles by Kiran T. Thakur

Kiran T. Thakur

Department of Neurology - Columbia University Irving Medical Center

Victoria T. Chu

Government of the United States of America - Centers for Disease Control and Prevention (CDC)

Christine Hughes

Government of the United States of America - Centers for Disease Control and Prevention (CDC)

Carla Y. Kim

Cornell University - Department of Neurology

Shannon Fleck-Dardarian

Government of the United States of America - Centers for Disease Control and Prevention (CDC)

Katherine Barrett

Government of the United States of America - Centers for Disease Control and Prevention (CDC)

Elizabeth Matthews

University of Colorado, Aurora - Department of Neurology

Alanna Balbi

Cornell University - Department of Neurology

Amanda Bilski

Cornell University - Department of Neurology

Mashina Chomba

Cornell University - Department of Neurology

Ori Lieberman

Cornell University - Department of Neurology

Samuel Jacobsen

Cornell University - Department of Neurology

Sachin Agarwal

Columbia University - Division of Hospital and Critical Care Neurology

David Roh

Columbia University - Division of Hospital and Critical Care Neurology

Soojin Park

Columbia University - Division of Hospital and Critical Care Neurology

Vivian Ssonko

Cornell University - Department of Neurology

Wendy Silver

Cornell University - Department of Neurology

Wendy Vargas

Columbia University - Irving Medical Center; Cornell University - Department of Neurology; Columbia University - Columbia Multiple Sclerosis Center

Andrew Geneslaw

Columbia University, College of Physicians & Surgeons, Department of Pediatrics

Michelle Bell

Columbia University - Department of Neurology

Brandon Waters

University of North Carolina (UNC) at Chapel Hill - Department of Neurology; Cornell University - Department of Neurology

Agam Rao

Government of the United States of America - Centers for Disease Control and Prevention (CDC); Cornell University - Department of Neurology

Jan Claassen

Columbia University - Division of Hospital and Critical Care Neurology

Amelia Boehme

Columbia University Medical Center, Department of Neurology

Joshua Willey

Columbia University - Department of Neurology

Mitchell S.V. Elkind

Columbia University Medical Center, Department of Neurology

Magdalena Sobieszczyk

Columbia University - Aaron Diamond AIDS Research Center; Columbia University - Division of Infectious Diseases

Jason Zucker

Columbia University - Division of Infectious Diseases

Andrea McCollum

Government of the United States of America - Division of High Consequence Pathogens and Pathology; Government of the United States of America - Centers for Disease Control and Prevention (CDC)

James J. Sejvar

Government of the United States of America - Division of High Consequence Pathogens and Pathology; Government of the United States of America - Centers for Disease Control and Prevention (CDC)

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Multiple version iconThere are 2 versions of this paper

Abstract

Background: There have been numerous reports of neurological manifestations identified in hospitalized patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Here, we identify the spectrum of associated neurological symptoms and conditions, define the time course in the development of neurological conditions, address readmission rates and mortality risk post-hospitalization in a multiethnic urban cohort.    

Methods: We identify the occurrence of neurological diagnoses among patients with laboratory-confirmed SARS-CoV-2 infection in a multi-ethnic cohort in New York City. We compare demographic and clinical features of COVID-19 patients with neurological diagnoses during hospitalization to those without neurological diagnoses in a retrospective case-control study and examine hospital-related data and outcomes of death and readmission up to 6 months after acute hospitalization in a secondary case-only cohort analysis. A retrospective cohort study was performed of 532 hospitalized patients with neurological manifestations within 6 weeks of positive SARS-CoV-2 laboratory results between March 1, 2020 and August 31, 2020.

Findings: The most common neurological diagnoses included encephalopathy (478, 77.3%), stroke (99, 16.0%), and seizures (38, 7.1%).  Those with new neurological diagnoses were more likely than those without neurological diagnoses to be male (312, 58.6%), have baseline neurological comorbidities (193, 36.3%) and be treated in an intensive care unit (ICU) (330, 62.0%) [p for all comparisons < 0.0001]. Of the 394 (74.1%) cases that survived the acute hospitalization, more than half (220/394, 55.8%) were readmitted within 6 months, with a mortality rate of 23.2% during readmission.   

Conclusion: Among SARS-CoV-2 infected patients, a significant burden of neurological diagnoses exists, particularly in critically ill populations. Further research is needed to define the impact of neurological diagnoses during acute hospitalization on longitudinal post-coronavirus disease 2019 (COVID-19) related symptoms including neurocognitive impairment.

Funding Information: Supported by the Centers for Disease Control and Prevention (contract 75D30120C07986 to Westat), F30 MH114390 to OJL.

Declaration of Interests: MSVE: Dr. Elkind receives royalties from UpToDate for a chapter on COVID-19 and neurological disease. Dr. Sobieszczyk was funded by a COVID supplement to the National Institute Of Allergy And Infectious Diseases of the National Institutes of Health under Award Number UM1AI06947. No other interests to declare.

Ethics Approval Statement: This study received approval from CUIMC institutional review board (IRB) with a waiver of written informed consent for retrospective analysis.

Keywords: COVID-19, SARS-CoV-2, neurological diagnoses, Encephalopathy

Suggested Citation

Thakur, Kiran T. and Chu, Victoria T. and Hughes, Christine and Y. Kim, Carla and Fleck-Dardarian, Shannon and Barrett, Katherine and Matthews, Elizabeth and Balbi, Alanna and Bilski, Amanda and Chomba, Mashina and Lieberman, Ori and Jacobsen, Samuel and Agarwal, Sachin and Roh, David and Park, Soojin and Ssonko, Vivian and Silver, Wendy and Vargas, Wendy and Geneslaw, Andrew and Bell, Michelle and Waters, Brandon and Rao, Agam and Claassen, Jan and Boehme, Amelia and Willey, Joshua and Elkind, Mitchell S.V. and Sobieszczyk, Magdalena and Zucker, Jason and McCollum, Andrea and Sejvar, James J., Risk Factors for New Neurological Diagnoses in Hospitalized COVID-19 Patients: A Case-Control Study in New York City. Available at SSRN: https://ssrn.com/abstract=3989855 or http://dx.doi.org/10.2139/ssrn.3989855

Kiran T. Thakur (Contact Author)

Department of Neurology - Columbia University Irving Medical Center ( email )

Victoria T. Chu

Government of the United States of America - Centers for Disease Control and Prevention (CDC) ( email )

1600 Clifton Rd., NE
Atlanta, GA 30333
United States

Christine Hughes

Government of the United States of America - Centers for Disease Control and Prevention (CDC) ( email )

1600 Clifton Rd., NE
Atlanta, GA 30333
United States

Carla Y. Kim

Cornell University - Department of Neurology ( email )

New York, NY
United States

Shannon Fleck-Dardarian

Government of the United States of America - Centers for Disease Control and Prevention (CDC) ( email )

1600 Clifton Rd., NE
Atlanta, GA 30333
United States

Katherine Barrett

Government of the United States of America - Centers for Disease Control and Prevention (CDC) ( email )

Atlanta
United States

Elizabeth Matthews

University of Colorado, Aurora - Department of Neurology ( email )

Alanna Balbi

Cornell University - Department of Neurology ( email )

New York, NY
United States

Amanda Bilski

Cornell University - Department of Neurology ( email )

New York, NY
United States

Mashina Chomba

Cornell University - Department of Neurology ( email )

New York, NY
United States
+260977275037 (Phone)

Ori Lieberman

Cornell University - Department of Neurology ( email )

New York, NY
United States

Samuel Jacobsen

Cornell University - Department of Neurology ( email )

New York, NY
United States

Sachin Agarwal

Columbia University - Division of Hospital and Critical Care Neurology ( email )

David Roh

Columbia University - Division of Hospital and Critical Care Neurology ( email )

Soojin Park

Columbia University - Division of Hospital and Critical Care Neurology ( email )

Vivian Ssonko

Cornell University - Department of Neurology ( email )

New York, NY
United States

Wendy Silver

Cornell University - Department of Neurology ( email )

New York, NY
United States
12123426867 (Phone)

Wendy Vargas

Columbia University - Irving Medical Center ( email )

William Black Building, 8th Floor BB8-801C
NY

Cornell University - Department of Neurology ( email )

New York, NY
United States

Columbia University - Columbia Multiple Sclerosis Center ( email )

Andrew Geneslaw

Columbia University, College of Physicians & Surgeons, Department of Pediatrics ( email )

NY
United States

Michelle Bell

Columbia University - Department of Neurology ( email )

New York, NY
United States

Brandon Waters

University of North Carolina (UNC) at Chapel Hill - Department of Neurology ( email )

United States

Cornell University - Department of Neurology ( email )

New York, NY
United States

Agam Rao

Government of the United States of America - Centers for Disease Control and Prevention (CDC) ( email )

1600 Clifton Rd., NE
Atlanta, GA 30333
United States

Cornell University - Department of Neurology ( email )

New York, NY
United States

Jan Claassen

Columbia University - Division of Hospital and Critical Care Neurology ( email )

Amelia Boehme

Columbia University Medical Center, Department of Neurology ( email )

College of Physicians and Surgeons
630 West 168th Street, 3rd Floor, Suite 3-470
New York, NY 10032-3784
United States

Joshua Willey

Columbia University - Department of Neurology ( email )

New York, NY
United States

Mitchell S.V. Elkind

Columbia University Medical Center, Department of Neurology

College of Physicians and Surgeons
630 West 168th Street, 3rd Floor, Suite 3-470
New York, NY 10032-3784
United States

Magdalena Sobieszczyk

Columbia University - Aaron Diamond AIDS Research Center ( email )

Columbia University - Division of Infectious Diseases ( email )

United States

Jason Zucker

Columbia University - Division of Infectious Diseases ( email )

Andrea McCollum

Government of the United States of America - Division of High Consequence Pathogens and Pathology ( email )

Atlanta, GA
United States

Government of the United States of America - Centers for Disease Control and Prevention (CDC) ( email )

1600 Clifton Rd., NE
Atlanta, GA 30333
United States

James J. Sejvar

Government of the United States of America - Division of High Consequence Pathogens and Pathology ( email )

Atlanta, GA
United States

Government of the United States of America - Centers for Disease Control and Prevention (CDC) ( email )

1600 Clifton Rd., NE
Atlanta, GA 30333
United States