In-hospital outcomes in patients with and without epilepsy diagnosed with COVID-19—A cohort study

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.