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

Abstract

Background: There have been numerous reports of neurological manifestations identified in hospitalized patients infected with SARS-CoV-2, the virus that causes COVID-19. Here, we identify the spectrum of associated neurological symptoms and diagnoses, define the time course of their development, examine readmission rates and mortality risk post-hospitalization in a multiethnic urban cohort.   

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

Findings: Among the 532 cases, the most common new neurological diagnoses included encephalopathy (478, 77.3%), stroke (99, 16.0%), and seizures (38, 7.1%). In the case-control study, cases were more likely than controls to be male (58.6% vs. 52.8%, p=0.05), have baseline neurological comorbidities (36.3% vs. 13.0%, p<0.0001) and be treated in an intensive care unit (ICU) (62.0% vs 9.6%, p < 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: Many patients hospitalized with SARS-CoV-2 have new neurological diagnoses. Further research is needed to define the impact of neurological diagnoses during acute hospitalization on longitudinal post-COVID-19 related symptoms including neurocognitive impairment. 

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

Declaration of Interests: 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

Ethics Approval Statement: This activity was reviewed by CDC and was conducted in a manner consistent with applicable federal law and CDC policy (45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.) as a public health non-research project. 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