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Prognostic Indicators and Outcomes of Hospitalised Covid-19 Patients With Neurological Disease: An Individual Patient Data Meta-Analysis Publisher Pubmed



Singh B1, 2, 3 ; Lant S1 ; Cividini S4 ; Cattrall JWS1 ; Goodwin LC1, 2 ; Benjamin L5 ; Michael BD1, 6 ; Khawaja A7 ; Matos ADMB8 ; Alkeridy W9 ; Pilotto A10 ; Lahiri D11 ; Rawlinson R1 ; Mhlanga S1 Show All Authors
Authors
  1. Singh B1, 2, 3
  2. Lant S1
  3. Cividini S4
  4. Cattrall JWS1
  5. Goodwin LC1, 2
  6. Benjamin L5
  7. Michael BD1, 6
  8. Khawaja A7
  9. Matos ADMB8
  10. Alkeridy W9
  11. Pilotto A10
  12. Lahiri D11
  13. Rawlinson R1
  14. Mhlanga S1
  15. Lopez EC1
  16. Sargent BF1
  17. Somasundaran A1
  18. Tamborska A1
  19. Webb G1
  20. Younas K1
  21. Al Sami Y12
  22. Babu H13
  23. Banks T14
  24. Cavallieri F15
  25. Cohen M16
  26. Davies E17
  27. Dhar S13
  28. Modol AF1
  29. Farooq H17
  30. Harte J18
  31. Hey S19
  32. Joseph A12
  33. Karthikappallil D16
  34. Kassahun D20
  35. Lipunga G21
  36. Mason R22
  37. Minton T23
  38. Mond G24
  39. Poxon J25
  40. Rabas S26
  41. Soothill G27
  42. Zedde M15
  43. Yenkoyan K28
  44. Brew B29
  45. Contini E29
  46. Cysique L29
  47. Zhang X29
  48. Maggi P30
  49. Van Pesch V30
  50. Lechien J31
  51. Saussez S31
  52. Heyse A32
  53. Brito Ferreira ML33
  54. Soares CN34
  55. Elicer I35
  56. Eugeninvon Bernhardi L35
  57. Reyes WN36
  58. Yin R37
  59. Azab MA38
  60. Abdallah F39
  61. Elkady A40
  62. Escalard S41
  63. Corvol JC42
  64. Delorme C42
  65. Tattevin P43
  66. Bigaut K44
  67. Lorenz N45
  68. Hornuss D46
  69. Hosp J46
  70. Rieg S46
  71. Wagner D46
  72. Knier B47
  73. Lingor P47
  74. Winkler AS47
  75. Sharifirazavi A48
  76. Moein ST49
  77. Seyed Alinaghi SA50
  78. Jamali Moghadam Siahkali S50
  79. Morassi M51
  80. Padovani A52
  81. Giunta M52
  82. Libri I52
  83. Beretta S53
  84. Ravaglia S54
  85. Foschi M55
  86. Calabresi P56
  87. Primiano G56
  88. Servidei S56
  89. Mercuri NB57
  90. Liguori C57
  91. Pierantozzi M57
  92. Sarmati L57
  93. Boso F58
  94. Garazzino S59
  95. Mariotto S60
  96. Patrick KN61
  97. Costache O62
  98. Pincherle A62
  99. Klok FA63
  100. Meza R64
  101. Cabreira V65
  102. Valdoleiros SR66
  103. Oliveira V66
  104. Kaimovsky I67
  105. Guekht A68
  106. Koh J69
  107. Diaz EF70
  108. Barrioslopez JM71
  109. Guijarrocastro C72
  110. Beltrancorbellini A73
  111. Martinezpoles J73
  112. Diezmamartin AM74
  113. Moralescasado MI74
  114. Garcia SG75
  115. Breville G76
  116. Coen M76
  117. Uginet M76
  118. Bernardvalnet R77
  119. Pasquier RD77
  120. Kaya Y78
  121. Abdelnour LH79
  122. Rice C80
  123. Morrison H81
  124. Defres S2
  125. Huda S6
  126. Enright N82
  127. Hassell J82
  128. Danna L83
  129. Benger M26
  130. Sztriha L26
  131. Raith E84
  132. Chinthapalli K85
  133. Nortley R85
  134. Paterson R85
  135. Chandratheva A86
  136. Werring DJ86
  137. Dervisevic S87
  138. Harkness K88
  139. Pinto A89
  140. Jillella D90
  141. Beach S91
  142. Gunasekaran K92
  143. Ferreira Da Silva IR93
  144. Nalleballe K94
  145. Santoro J95
  146. Scullen T96
  147. Kahn L96
  148. Kim CY97
  149. Thakur KT97
  150. Jain R98
  151. Umapathi T99
  152. Nicholson TR100
  153. Sejvar JJ101
  154. Hodel EM1
  155. Smith CT4
  156. Solomon T1, 2, 6
Show Affiliations
Authors Affiliations
  1. 1. National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
  2. 2. Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  3. 3. Department of Infectious Diseases, Christian Medical College, Vellore, India
  4. 4. Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
  5. 5. Queen Square Institute of Neurology, University College London, London, United Kingdom
  6. 6. Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
  7. 7. Department of Neurology, Wayne State University, Detroit, MI, United States
  8. 8. Instituto de Medicina Tropical, Universidade de Sao Paulo, Sao Paulo, Brazil
  9. 9. Department of Medicine, King Saud University, Riyadh, Saudi Arabia
  10. 10. Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
  11. 11. Bangur Institute of Neurosciences, Institute of Post-Graduate Medical Education and Research, Kolkata, India
  12. 12. Homerton University Hospital NHS Foundation Trust, London, United Kingdom
  13. 13. Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
  14. 14. Department of Infection, Manchester University NHS Foundation Trust, Manchester, United Kingdom
  15. 15. Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
  16. 16. Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
  17. 17. Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom
  18. 18. Barts Health NHS Trust, London, United Kingdom
  19. 19. Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom
  20. 20. Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom
  21. 21. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
  22. 22. Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom
  23. 23. Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom
  24. 24. North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom
  25. 25. Epsom and St Helier University Hospitals NHS Foundation Trust, United Kingdom
  26. 26. King’s College Hospital NHS Foundation Trust, London, United Kingdom
  27. 27. Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, United Kingdom
  28. 28. Yerevan State Medical University named after Mkhitar Heratsi, Neuroscience Laboratory, Cobrain Center, Yerevan, Armenia
  29. 29. St Vincent’s Hospital, Sydney, Australia
  30. 30. Saint-Luc University Hospital, Brussels, Belgium
  31. 31. Universite de Mons, Mons, Belgium
  32. 32. AZ Glorieux, Ronse, Belgium
  33. 33. Hospital da Restauracao, Recife, Brazil
  34. 34. Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
  35. 35. Hospital Dr. Sotero del Rio, Santiago, Chile
  36. 36. Universidad de Chile - Hospital Barros Luco Trudeau, Santiago, Chile
  37. 37. 940th Hospital of Joint Logistic Support Force of the People’s Liberation Army, Lanzhou, China
  38. 38. Cairo University Hospital, Cairo, Egypt
  39. 39. Kasr Alainy Teaching Hospital, Cairo, Egypt
  40. 40. Mataria Teaching Hospital, Cairo, Egypt
  41. 41. Fondation Rothschild, Paris, France
  42. 42. Pitie Salpetriere Hospital, Paris, France
  43. 43. Rennes University Hospital, Rennes, France
  44. 44. Hopitaux Universitaires de Strasbourg, Strasbourg, France
  45. 45. Children’s Hospital, Dresden Municipal Hospital Teaching Hospital TUD, Dresden, Germany
  46. 46. Medical Center University of Freiburg, Freiburg, Germany
  47. 47. Department of Neurology, Technical University of Munich, Munich, Germany
  48. 48. Mazandaran University of Medical Science, Sari, Iran
  49. 49. Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
  50. 50. Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran
  51. 51. Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
  52. 52. University of Brescia, Brescia, Italy
  53. 53. San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
  54. 54. Fondazione Mondino IRCCS, Pavia, Italy
  55. 55. Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
  56. 56. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  57. 57. University Hospital of Rome Tor Vergata, Rome, Italy
  58. 58. Healthcare Trust of the Autonomous Region of Trento, Rovereto, Italy
  59. 59. Citta della Salute e della Scienza di Torino, Regina Margherita Children’s Hospital, Turin, Italy
  60. 60. University of Verona, Verona, Italy
  61. 61. Halcyon Healthcare Limited, Nairobi, Kenya
  62. 62. Hopitaux Robert Schuman, Luxembourg, Luxembourg
  63. 63. Leiden University Medical Center, Leiden, Netherlands
  64. 64. Hospital Regional Docente de Trujillo, Trujillo, Peru
  65. 65. Centro Hospitalar Sao Joao, Porto, Portugal
  66. 66. Centro Hospitalar Universitario do Porto, Porto, Portugal
  67. 67. Buyanov Moscow City Hospital, Moscow, Russian Federation
  68. 68. Moscow Research and Clinical Center for Neuropsychiatry and Buyanov Moscow City Hospital, Moscow, Russian Federation
  69. 69. National Neuroscience Institute, Singapore, Singapore
  70. 70. Complejo Hospitalario Universitario de Albacete, Albacete, Spain
  71. 71. Hospital Universitario Virgen de las Nieves, Granada, Spain
  72. 72. University Hospital Sanchinarro, Madrid, Spain
  73. 73. University Hospital Ramon y Cajal, Madrid, Spain
  74. 74. Hospital Virgen de la Salud, Toledo, Spain
  75. 75. Hospital del Rio Hortega, Valladolid, Spain
  76. 76. Hopitaux Universitaires de Geneve, Geneva, Switzerland
  77. 77. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  78. 78. Acibadem Mehmet Ali Aydinlar University Medical School, Istanbul, Turkey
  79. 79. Ulster Hospital, Belfast, United Kingdom
  80. 80. University of Bristol, North Bristol NHS Trust, Bristol, United Kingdom
  81. 81. Gloucestershire Royal Hospital, Gloucester, United Kingdom
  82. 82. Great Ormond Street Hospital for Children, London, United Kingdom
  83. 83. Imperial College London, London, United Kingdom
  84. 84. National Hospital for Neurology and Neurosurgery, London, United Kingdom
  85. 85. University College London, London, United Kingdom
  86. 86. University College London Queen Square Institute of Neurology, London, United Kingdom
  87. 87. Eastern Pathology Alliance Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
  88. 88. Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom
  89. 89. Wessex Neurological Centre, Southampton, United Kingdom
  90. 90. Emory University School of Medicine, Atlanta, GA, United States
  91. 91. Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
  92. 92. Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, United States
  93. 93. Rush University Medical Center, Chicago, IL, United States
  94. 94. University of Arkansas for Medical Sciences, Little Rock, AR, United States
  95. 95. Children’s Hospital Los Angeles, Keck School of Medicine, The University of Southern California, Los Angeles, CA, United States
  96. 96. Ochsner Medical Center, New Orleans, Los Angeles, United States
  97. 97. Columbia University Irving Medical Center, New York, NY, United States
  98. 98. New York University Grossman School of Medicine, New York, NY, United States
  99. 99. Department of Neurology, National Neuroscience Institute, Singapore, Singapore
  100. 100. Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
  101. 101. Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States

Source: PLoS ONE Published:2022


Abstract

Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission. © 2022 Public Library of Science. All rights reserved.