Neurological Prognostic Factors in Hospitalized Patients with COVID-19.

Leszek Drabik,Tomasz Kesek,Aleksander Garlicki,Malgorzata Wojcik-Bugajska,Maciej Malecki,Justyna Derbisz,Ralph Jozefowicz,Marcin Wnuk,Iwona Mazurkiewicz,Agnieszka Slowik,Katarzyna Sawczynska,Zaneta Chatys-Bogacka,Jacek Czepiel,Joanna Szaleniec,Pawel Wrona

doi:10.3390/brainsci12020193

Abstract

We aimed to search whether neurological symptoms or signs (NSS) and the MEWS (Modified Early Warning Score) score were associated with in-hospital mortality or oxygen requirement during the first 14 days of hospitalization in COVID-19 patients recruited at the University Hospital in Krakow, Poland. The detailed clinical questionnaires on twenty NSS were either filled out by patients prospectively or retrospectively assessed by neurologists based on daily medical records. NSS were considered high or low-risk if they were associated with increased or decreased mortality in the univariable analysis. This cohort study included 349 patients with COVID-19 (median age 64, interquartile range (51–77), women 54.72%). The presence of high-risk NSS (decreased level of consciousness, delirium, seizures, and symptoms of stroke or transient ischemic attack) or its combination with the absence of low-risk NSS (headache, dizziness, decreased mood, and fatigue) increased the risk of in-hospital mortality in SARS-CoV-2 infection 3.13 and 7.67-fold, respectively. The presence of low-risk NSS decreased the risk of in-hospital mortality in COVID-19 patients more than 6-fold. Death in patients with SARS-CoV-2 infection, apart from NSS, was predicted by older age, neoplasm, and higher MEWS scores on admission. High-risk NSS or their combination with the absence of low-risk NSS increased the risk of oxygen requirement during hospitalization in COVID-19 patients 4.48 and 1.86-fold, respectively. Independent predictors of oxygen therapy during hospitalization in patients with SARS-CoV-2 infection were also older age, male sex, neoplasm, and higher MEWS score on admission.

Highlights

The Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection caused a significant burden for public health systems, with over 5.5 million deaths worldwide as of 22 January 2022 [1]
We gathered the data on basic demographics, concomitant chronic diseases with special emphasis on cardiovascular and neurological disorders, COVID-19 symptomatology, and blood parameters previously associated with poorer COVID-19 prognosis, which were troponin I [29] and D-dimer levels [30]
The detailed clinical questionnaires on the presence of 20 neurological symptoms or signs (NSS), including 12 symptoms and 8 signs, were either filled out by patients prospectively during the first 14 days of hospitalization or retrospectively assessed by neurologists based on daily medical records in the hospital database

Summary

Introduction

The Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection caused a significant burden for public health systems, with over 5.5 million deaths worldwide as of 22 January 2022 [1]. The broad variety of neurological symptoms in the course of SARS-CoV-2 infection ranged from mild manifestations, including myalgia, headache [5], fatigue, dizziness, and anosmia, to more severe presentations, such as seizures, stroke, and encephalopathy [6]. Involvement of both the central and peripheral nervous systems was common within the first 14 days of the SARS-CoV-2 infection [7]. A substantial number of patients experienced persistent neurological symptoms within 90 days after discharge from the COVID-19 ward [8]

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