COVID-19 Outcomes of 10,881 Patients: Retrospective Study Of Neurological Symptoms and Associated Manifestations (Philippine CORONA Study)

Abstract

Background: Our study aimed to determine the effects of new-onset neurological symptoms (NNS) on clinically relevant outcomes in hospitalized patients with COVID-19 infection. Methods: We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines. Adjusted hazard ratios (aHR) and odds ratios (aOR) were calculated for the obtained clinically relevant outcomes of the study. Results: We included a total of 10,881 patients with confirmed COVID-19 infection (2,008 had NNS while 8,873 did not have NNS); median age was 52 (36–64) and female:male ratio was 1:1.13. The most common NNS were headache (n=607, 5.58%), anosmia/hyposmia (n=544, 5.0%) and altered sensorium (n=479, 4.4%). Among the mild and severe cases, the aHRs for mortality were significantly higher by 1.660 (95% CI 1.132–2.435) and by 1.352 (95% CI 1.042–1.752), respectively, in the NNS group compared to those in the non-NNS group. The aHRs for respiratory failure in the NNS group were significantly increased by 1.914 (95% CI 1.346–2.722), by 1.614 (95% CI 1.260–2.068), and by 1.234 (95% CI 1.089–1.398) among the mild, severe, and critical cases, respectively. The aHRs for ICU admission in the NNS group were still significantly higher by 1.973 (95% CI 1.457–2.673) and by 1.831 (95% CI 1.506–2.226) among the mild and severe cases, respectively. Patients who had NNS were not significantly associated with a longer duration of ventilator dependence (aOR 0.954, 95% CI 0.772–1.179), longer ICU stay (aOR 0.983, 95% CI 0.772–1.252) and longer hospital admission (aOR 1.045, 95% CI 0.947 – 1.153). Conclusions: The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients. Clinical Trial Registration Details: ClinicalTrials.gov website (NCT04386083). Funding Information: (1) Philippine Neurological Association, Room 1006, Rear Tower Cathedral Height Building Complex, St. Luke’s Medical Center, E. Rodriguez Avenue,Manila, Philippines (Grant number: Not applicable); and (2) Expanded Hospital Research Office, University of the Philippines- Philippine General Hospital, Taft Avenue, Manila, Philippines (Grant number: Not applicable). Declaration of Interests: All authors declare no conflict of interest. Ethics Approval Statement: This study was approved by relevant institutional research boards of the hospital sites.