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A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications

2021; Elsevier BV; Volume: 426; Linguagem: Inglês

10.1016/j.jns.2021.117486

1878-5883

Jennifer Frontera, Dixon Yang, Ariane Lewis, Palak Patel, Chaitanya Medicherla, Vito Arena, Taolin Fang, Andres Andino, Thomas E. Snyder, Maya Madhavan, Daniel Gratch, Benjamin Fuchs, Alexa Dessy, Melanie Canizares, Ruben Jauregui, Betsy Thomas, Kristie Bauman, Anlys Olivera, Dhristie Bhagat, Michael Sonson, George Park, Rebecca Stainman, Brian Sunwoo, Daniel Talmasov, Michael Tamimi, Yingrong Zhu, Jonathan Rosenthal, Levi Dygert, Milan Ristic, Haruki Ishii, Eduard Valdes, Mirza Omari, Lindsey Gurin, Joshua Zhexue Huang, Barry Czeisler, D. Ethan Kahn, Ting Zhou, Jessica Lin, Aaron Lord, Kara Melmed, Sharon B. Meropol, Andrea B. Troxel, Eva Petkova, Thomas Wısnıewskı, Laura J. Balcer, Chris Morrison, Shadi Yaghi, Steven Galetta,

COVID-19 Clinical Research Studies

BackgroundLittle is known regarding long-term outcomes of patients hospitalized with COVID-19.MethodsWe conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep.ResultsOf 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N = 196 neurological patients and N = 186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 1.98, 95%CI 1.23–3.48, P = 0.02), worse ADLs (aOR 0.38, 95%CI 0.29–0.74, P = 0.01) and were less likely to return to work than controls (41% versus 64%, P = 0.04). Cognitive and Neuro-QOL metrics were similar between groups.ConclusionsAbnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.