A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

Jennifer A. Frontera; Sakinah Sabadia; Rebecca Lalchan; Taolin Fang; Brent Flusty; Patricio Millar-Vernetti; Thomas Snyder; Stephen Berger; Dixon Yang; Andre Granger; Nicole Morgan; Palak Patel; Josef Gutman; Kara Melmed; Shashank Agarwal; Matthew Bokhari; Andres Andino; Eduard Valdes; Mirza Omari; Alexandra Kvernland; Kaitlyn Lillemoe; Sherry H.Y. Chou; Molly McNett; Raimund Helbok; Shraddha Mainali; Ericka L. Fink; Courtney Robertson; Michelle Schober; Jose I. Suarez; Wendy Ziai; David Menon; Daniel Friedman; David Friedman; Manisha Holmes; Joshua Huang; Sujata Thawani; Jonathan Howard; Nada Abou-Fayssal; Penina Krieger; Ariane Lewis; Aaron S. Lord; Ting Zhou; D. Ethan Kahn; Barry M. Czeisler; Jose Torres; Shadi Yaghi; Koto Ishida; Erica Scher; Adam De Havenon; Dimitris Placantonakis; Mengling Liu; Thomas Wisniewski; Andrea B. Troxel; Laura Balcer; Steven Galetta

doi:10.1212/WNL.0000000000010979

A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

Jennifer A. Frontera, Sakinah Sabadia, Rebecca Lalchan, Taolin Fang, Brent Flusty, Patricio Millar-Vernetti, Thomas Snyder, Stephen Berger, Dixon Yang, Andre Granger, Nicole Morgan, Palak Patel, Josef Gutman, Kara Melmed, Shashank Agarwal, Matthew Bokhari, Andres Andino, Eduard Valdes, Mirza Omari, Alexandra KvernlandKaitlyn Lillemoe, Sherry H.Y. Chou, Molly McNett, Raimund Helbok, Shraddha Mainali, Ericka L. Fink, Courtney Robertson, Michelle Schober, Jose I. Suarez, Wendy Ziai, David Menon, Daniel Friedman, David Friedman, Manisha Holmes, Joshua Huang, Sujata Thawani, Jonathan Howard, Nada Abou-Fayssal, Penina Krieger, Ariane Lewis, Aaron S. Lord, Ting Zhou, D. Ethan Kahn, Barry M. Czeisler, Jose Torres, Shadi Yaghi, Koto Ishida, Erica Scher, Adam De Havenon, Dimitris Placantonakis, Mengling Liu, Thomas Wisniewski, Andrea B. Troxel, Laura Balcer, Steven Galetta

Research output: Contribution to journal › Article › peer-review

227 Scopus citations

Abstract

ObjectiveTo determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.MethodsWe conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.ResultsOf 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001).ConclusionsNeurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.

Original language	English
Pages (from-to)	E575-E586
Journal	Neurology
Volume	96
Issue number	4
DOIs	https://doi.org/10.1212/WNL.0000000000010979
State	Published - 26 Jan 2021
Externally published	Yes

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Frontera, J. A., Sabadia, S., Lalchan, R., Fang, T., Flusty, B., Millar-Vernetti, P., Snyder, T., Berger, S., Yang, D., Granger, A., Morgan, N., Patel, P., Gutman, J., Melmed, K., Agarwal, S., Bokhari, M., Andino, A., Valdes, E., Omari, M., ... Galetta, S. (2021). A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City. Neurology, 96(4), E575-E586. https://doi.org/10.1212/WNL.0000000000010979

@article{a1e979184bf744d8aa0ba4247f9da9ee,

title = "A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City",

abstract = "ObjectiveTo determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.MethodsWe conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.ResultsOf 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001).ConclusionsNeurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.",

author = "Frontera, {Jennifer A.} and Sakinah Sabadia and Rebecca Lalchan and Taolin Fang and Brent Flusty and Patricio Millar-Vernetti and Thomas Snyder and Stephen Berger and Dixon Yang and Andre Granger and Nicole Morgan and Palak Patel and Josef Gutman and Kara Melmed and Shashank Agarwal and Matthew Bokhari and Andres Andino and Eduard Valdes and Mirza Omari and Alexandra Kvernland and Kaitlyn Lillemoe and Chou, {Sherry H.Y.} and Molly McNett and Raimund Helbok and Shraddha Mainali and Fink, {Ericka L.} and Courtney Robertson and Michelle Schober and Suarez, {Jose I.} and Wendy Ziai and David Menon and Daniel Friedman and David Friedman and Manisha Holmes and Joshua Huang and Sujata Thawani and Jonathan Howard and Nada Abou-Fayssal and Penina Krieger and Ariane Lewis and Lord, {Aaron S.} and Ting Zhou and Kahn, {D. Ethan} and Czeisler, {Barry M.} and Jose Torres and Shadi Yaghi and Koto Ishida and Erica Scher and {De Havenon}, Adam and Dimitris Placantonakis and Mengling Liu and Thomas Wisniewski and Troxel, {Andrea B.} and Laura Balcer and Steven Galetta",

note = "Publisher Copyright: {\textcopyright} American Academy of Neurology.",

year = "2021",

month = jan,

day = "26",

doi = "10.1212/WNL.0000000000010979",

language = "English",

volume = "96",

pages = "E575--E586",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "4",

}

Frontera, JA, Sabadia, S, Lalchan, R, Fang, T, Flusty, B, Millar-Vernetti, P, Snyder, T, Berger, S, Yang, D, Granger, A, Morgan, N, Patel, P, Gutman, J, Melmed, K, Agarwal, S, Bokhari, M, Andino, A, Valdes, E, Omari, M, Kvernland, A, Lillemoe, K, Chou, SHY, McNett, M, Helbok, R, Mainali, S, Fink, EL, Robertson, C, Schober, M, Suarez, JI, Ziai, W, Menon, D, Friedman, D, Friedman, D, Holmes, M, Huang, J, Thawani, S, Howard, J, Abou-Fayssal, N, Krieger, P, Lewis, A, Lord, AS, Zhou, T, Kahn, DE, Czeisler, BM, Torres, J, Yaghi, S, Ishida, K, Scher, E, De Havenon, A, Placantonakis, D, Liu, M, Wisniewski, T, Troxel, AB, Balcer, L & Galetta, S 2021, 'A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City', Neurology, vol. 96, no. 4, pp. E575-E586. https://doi.org/10.1212/WNL.0000000000010979

TY - JOUR

T1 - A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

AU - Frontera, Jennifer A.

AU - Sabadia, Sakinah

AU - Lalchan, Rebecca

AU - Fang, Taolin

AU - Flusty, Brent

AU - Millar-Vernetti, Patricio

AU - Snyder, Thomas

AU - Berger, Stephen

AU - Yang, Dixon

AU - Granger, Andre

AU - Morgan, Nicole

AU - Patel, Palak

AU - Gutman, Josef

AU - Melmed, Kara

AU - Agarwal, Shashank

AU - Bokhari, Matthew

AU - Andino, Andres

AU - Valdes, Eduard

AU - Omari, Mirza

AU - Kvernland, Alexandra

AU - Lillemoe, Kaitlyn

AU - Chou, Sherry H.Y.

AU - McNett, Molly

AU - Helbok, Raimund

AU - Mainali, Shraddha

AU - Fink, Ericka L.

AU - Robertson, Courtney

AU - Schober, Michelle

AU - Suarez, Jose I.

AU - Ziai, Wendy

AU - Menon, David

AU - Friedman, Daniel

AU - Friedman, David

AU - Holmes, Manisha

AU - Huang, Joshua

AU - Thawani, Sujata

AU - Howard, Jonathan

AU - Abou-Fayssal, Nada

AU - Krieger, Penina

AU - Lewis, Ariane

AU - Lord, Aaron S.

AU - Zhou, Ting

AU - Kahn, D. Ethan

AU - Czeisler, Barry M.

AU - Torres, Jose

AU - Yaghi, Shadi

AU - Ishida, Koto

AU - Scher, Erica

AU - De Havenon, Adam

AU - Placantonakis, Dimitris

AU - Liu, Mengling

AU - Wisniewski, Thomas

AU - Troxel, Andrea B.

AU - Balcer, Laura

AU - Galetta, Steven

PY - 2021/1/26

Y1 - 2021/1/26

N2 - ObjectiveTo determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.MethodsWe conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.ResultsOf 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001).ConclusionsNeurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.

AB - ObjectiveTo determine the prevalence and associated mortality of well-defined neurologic diagnoses among patients with coronavirus disease 2019 (COVID-19), we prospectively followed hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients and recorded new neurologic disorders and hospital outcomes.MethodsWe conducted a prospective, multicenter, observational study of consecutive hospitalized adults in the New York City metropolitan area with laboratory-confirmed SARS-CoV-2 infection. The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between patients with COVID-19 with and without neurologic disorders.ResultsOf 4,491 patients with COVID-19 hospitalized during the study timeframe, 606 (13.5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset. The most common diagnoses were toxic/metabolic encephalopathy (6.8%), seizure (1.6%), stroke (1.9%), and hypoxic/ischemic injury (1.4%). No patient had meningitis/encephalitis or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were reverse transcriptase PCR negative for SARS-CoV-2. Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all p < 0.05). After adjusting for age, sex, SOFA scores, intubation, history, medical complications, medications, and comfort care status, patients with COVID-19 with neurologic disorders had increased risk of in-hospital mortality (hazard ratio [HR] 1.38, 95% confidence interval [CI] 1.17-1.62, p < 0.001) and decreased likelihood of discharge home (HR 0.72, 95% CI 0.63-0.85, p < 0.001).ConclusionsNeurologic disorders were detected in 13.5% of patients with COVID-19 and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home. Many observed neurologic disorders may be sequelae of severe systemic illness.

UR - http://www.scopus.com/inward/record.url?scp=85100332852&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000010979

DO - 10.1212/WNL.0000000000010979

M3 - Article

C2 - 33020166

AN - SCOPUS:85100332852

SN - 0028-3878

VL - 96

SP - E575-E586

JO - Neurology

JF - Neurology

IS - 4

ER -

A Prospective Study of Neurologic Disorders in Hospitalized Patients With COVID-19 in New York City

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