A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City

Objective: To determine the prevalence and associated mortality of well-defined neurologic diagnoses among COVID-19 patients, we prospectively followed hospitalized SARS-Cov-2 positive patients and recorded new neurologic disorders and hospital outcomes. Methods: We conducted a prospective, multi-center, observational study of consecutive hospitalized adults in the NYC metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between COVID-19 patients with and without neurologic disorders. Results: Of 4,491 COVID-19 patients hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were: toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis, or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were RTPCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all P<0.05). After adjusting for age, sex, SOFA-scores, intubation, past history, medical complications, medications and comfort-care-status, COVID-19 patients with neurologic disorders had increased risk of in-hospital mortality (Hazard Ratio[HR] 1.38, 95% CI 1.17-1.62, P<0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, P<0.001). AC CE PT ED Copyright © 2020 American Academy of Neurology. Unauthorized reproduction of this article is prohibited Conclusions: Neurologic disorders were detected in 13.5% of COVID-19 patients and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness. INTRODUCTION: The prevalence of neurologic findings in patients with SARS-CoV-2 infection ranges from 3.5-84% across studies . Reported COVID-19 related neurologic disorders include encephalopathy, anosmia, dysgeusia, headache, stroke, seizure, acute necrotizing encephalopathy, hypoxic ischemic brain injury, encephalitis and demyelinating polyneuropathy . However, discrepancies in methodology, neurologic event definitions, cohort size and ascertainment have contributed to variable reporting. Furthermore, there is a paucity of prospective data evaluating neurologic findings among COVID-19 patients. In this study we aimed to prospectively identify the prevalence of specific neurologic diagnoses among patients with laboratory confirmed SARS-CoV-2 infection and to determine the associated risk of in-hospital death compared to COVID-19 patients without neurologic disorders. We additionally aimed to compare hospital complications and discharge disposition between these groups. In a secondary analysis, we compared COVID-19 patients whose neurologic disorders occurred prior to, or at the time of admission, to patients who developed neurologic disorders later during hospitalization.