Neurologic Complications in Hospitalized COVID Patients Common, Deadly

Megan Brooks

May 11, 2021

Eight in 10 patients hospitalized with COVID-19 develop neurologic complications, and these patients are much more likely to die in hospital compared with their counterparts without neurologic complications, a global study shows.

Findings from the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) reveal 82% of hospitalized COVID-19 patients had neurologic manifestations and a sixfold increased mortality risk.

"We now know that neurological conditions are common in hospitalized patients with COVID-19, and in this large study we can see the impact of neurological conditions," principal investigator Sherry Chou, MD, MSc, told Medscape Medical News.

"Without really knowing whether the neurological conditions directly cause these patients to die, we do see that patients who have neurological conditions with COVID-19 were more likely to die while they're in the hospital," said Chou, associate professor of critical care medicine, neurology, and neurosurgery at the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

"The challenge to us as physicians and scientists is to figure out why and how we can prevent that," she added.

The findings were published online May 11 in JAMA Network Open.

Long Road Ahead

Among 3744 patients hospitalized with COVID-19, 82% developed neurological manifestations. The most common self-reported neurologic symptoms were headache (37%) and anosmia (loss of smell) or ageusia (loss of taste) (26%).

The most common neurologic signs and/or syndromes were acute encephalopathy (49%), coma (17%) and stroke (6%). Meningitis and/or encephalitis were rare (0.5%).

After adjusting for relevant cofactors including age, sex, and race/ethnicity, the presence of clinically captured neurologic signs and/or syndromes was associated with a sixfold increased risk of dying in the hospital (adjusted odds ratio [aOR], 5.99; 95% CI, 4.33 - 8.28).

"Having a preexisting neurological condition of any kind most reliably and most strongly predicted the development of COVID-19-related neurological complications. The risk is more than double compared to those who don't have a preexisting neurological condition," said Chou.

"For patients hospitalized with COVID-19 who develop neurological problems, it may take a very long time to recover. Many of these patients continue to deal with these symptoms and disabilities long after they have beat COVID," she said.

"Even if the pandemic is completely eradicated, we are still talking about millions of survivors who need our help," Chou added in a news release.

"It is important to find out what symptoms and health problems those patients are facing, and there is still plenty of work for years to come," she said.

Reached for comment, Shaheen E. Lakhan, MD, PhD, neurologist in Newton, Massachusetts, said "COVID-19 is now a bona-fide brain disease. The study not only highlights the alarming rate of serious brain manifestations of COVID-19, but also that these patients are more prone to intensive hospital care and death."

"Special attention must be paid to COVID-19 patients to proactively identify any neurological involvement, and, when present, consider early hospitalization, aggressive therapy, and more frequent and intensive clinical monitoring in all care settings," Lakhan, senior vice president of research & development, Click Therapeutics Inc, Boston, told Medscape Medical News.

The study is supported by the National Institutes of Health, National Center for Advancing Translational Sciences and the University of Pittsburgh Dean’s Faculty Advancement Award. Chou and Lakhan have disclosed no relevant financial relationships.

JAMA Netw Open. Published May 11, 2021. Full text

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