TY - JOUR
T1 - In-hospital outcomes in patients with and without epilepsy diagnosed with COVID-19—A cohort study
AU - Ufongene, Claire
AU - Van Hyfte, Grace
AU - Agarwal, Parul
AU - Blank, Leah J.
AU - Goldstein, Jonathan
AU - Mathew, Brian
AU - Lin, Jung Yi
AU - Navis, Allison
AU - McCarthy, Louise
AU - Gururangan, Kapil
AU - Peschansky, Veronica
AU - Kwon, Churl Su
AU - Cohen, Ariella
AU - Chan, Andy Ho Wing
AU - Dhamoon, Mandip
AU - Deng, Pojen
AU - Gutzwiller, Eveline M.
AU - Hao, Qing
AU - He, Celestine
AU - Heredia Nunez, Wilson D.
AU - Klenofsky, Britany
AU - Lemus, Hernan Nicolas
AU - Marcuse, Lara
AU - Roberts, Mallory
AU - Schorr, Emily M.
AU - Singh, Anuradha
AU - Tantillo, Gabriela
AU - Young, James
AU - Balchandani, Priti
AU - Festa, Joanne
AU - Naasan, Georges
AU - Charney, Alexander
AU - Nadkarni, Girish
AU - Jetté, Nathalie
N1 - Publisher Copyright:
© 2023 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
PY - 2023/10
Y1 - 2023/10
N2 - Objectives: Coronavirus disease 2019 (COVID-19) is associated with mortality in persons with comorbidities. The aim of this study was to evaluate in-hospital outcomes in patients with COVID-19 with and without epilepsy. Methods: We conducted a retrospective study of patients with COVID-19 admitted to a multicenter health system between March 15, 2020, and May 17, 2021. Patients with epilepsy were identified using a validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM case definition. Logistic regression models and Kaplan–Meier analyses were conducted for mortality and non-routine discharges (i.e., not discharged home). An ordinary least-squares regression model was fitted for length of stay (LOS). Results: We identified 9833 people with COVID-19 including 334 with epilepsy. On univariate analysis, people with epilepsy had significantly higher ventilator use (37.70% vs 14.30%, p <.001), intensive care unit (ICU) admissions (39.20% vs 17.70%, p <.001) mortality rate (29.60% vs 19.90%, p <.001), and longer LOS (12 days vs 7 days, p <.001). and fewer were discharged home (29.64% vs 57.37%, p <.001). On multivariate analysis, only non-routine discharge (adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 2.00–3.70; p <.001) and LOS (32.50% longer, 95% CI 22.20%–43.60%; p <.001) were significantly different. Factors associated with higher odds of mortality in epilepsy were older age (aOR 1.05, 95% CI 1.03–1.08; p <.001), ventilator support (aOR 7.18, 95% CI 3.12–16.48; p <.001), and higher Charlson comorbidity index (CCI) (aOR 1.18, 95% CI 1.04–1.34; p =.010). In epilepsy, admissions between August and December 2020 or January and May 2021 were associated with a lower odds of non-routine discharge and decreased LOS compared to admissions between March and July 2020, but this difference was not statistically significant. Significance: People with COVID-19 who had epilepsy had a higher odds of non-routine discharge and longer LOS but not higher mortality. Older age (≥65), ventilator use, and higher CCI were associated with COVID-19 mortality in epilepsy. This suggests that older adults with epilepsy and multimorbidity are more vulnerable than those without and should be monitored closely in the setting of COVID-19.
AB - Objectives: Coronavirus disease 2019 (COVID-19) is associated with mortality in persons with comorbidities. The aim of this study was to evaluate in-hospital outcomes in patients with COVID-19 with and without epilepsy. Methods: We conducted a retrospective study of patients with COVID-19 admitted to a multicenter health system between March 15, 2020, and May 17, 2021. Patients with epilepsy were identified using a validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM case definition. Logistic regression models and Kaplan–Meier analyses were conducted for mortality and non-routine discharges (i.e., not discharged home). An ordinary least-squares regression model was fitted for length of stay (LOS). Results: We identified 9833 people with COVID-19 including 334 with epilepsy. On univariate analysis, people with epilepsy had significantly higher ventilator use (37.70% vs 14.30%, p <.001), intensive care unit (ICU) admissions (39.20% vs 17.70%, p <.001) mortality rate (29.60% vs 19.90%, p <.001), and longer LOS (12 days vs 7 days, p <.001). and fewer were discharged home (29.64% vs 57.37%, p <.001). On multivariate analysis, only non-routine discharge (adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 2.00–3.70; p <.001) and LOS (32.50% longer, 95% CI 22.20%–43.60%; p <.001) were significantly different. Factors associated with higher odds of mortality in epilepsy were older age (aOR 1.05, 95% CI 1.03–1.08; p <.001), ventilator support (aOR 7.18, 95% CI 3.12–16.48; p <.001), and higher Charlson comorbidity index (CCI) (aOR 1.18, 95% CI 1.04–1.34; p =.010). In epilepsy, admissions between August and December 2020 or January and May 2021 were associated with a lower odds of non-routine discharge and decreased LOS compared to admissions between March and July 2020, but this difference was not statistically significant. Significance: People with COVID-19 who had epilepsy had a higher odds of non-routine discharge and longer LOS but not higher mortality. Older age (≥65), ventilator use, and higher CCI were associated with COVID-19 mortality in epilepsy. This suggests that older adults with epilepsy and multimorbidity are more vulnerable than those without and should be monitored closely in the setting of COVID-19.
KW - COVID-19
KW - comorbidity
KW - hospital outcomes
KW - neurological
KW - seizure
UR - http://www.scopus.com/inward/record.url?scp=85165945275&partnerID=8YFLogxK
U2 - 10.1111/epi.17715
DO - 10.1111/epi.17715
M3 - Article
C2 - 37452760
AN - SCOPUS:85165945275
SN - 0013-9580
VL - 64
SP - 2725
EP - 2737
JO - Epilepsia
JF - Epilepsia
IS - 10
ER -