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

Claire Ufongene, Grace Van Hyfte, Parul Agarwal, Leah J. Blank, Jonathan Goldstein, Brian Mathew, Jung Yi Lin, Allison Navis, Louise McCarthy, Kapil Gururangan, Veronica Peschansky, Churl Su Kwon, Ariella Cohen, Andy Ho Wing Chan, Mandip Dhamoon, Pojen Deng, Eveline M. Gutzwiller, Qing Hao, Celestine He, Wilson D. Heredia NunezBritany Klenofsky, Hernan Nicolas Lemus, Lara Marcuse, Mallory Roberts, Emily M. Schorr, Anuradha Singh, Gabriela Tantillo, James Young, Priti Balchandani, Joanne Festa, Georges Naasan, Alexander Charney, Girish Nadkarni, Nathalie Jetté

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Abstract

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.

Original languageEnglish
Pages (from-to)2725-2737
Number of pages13
JournalEpilepsia
Volume64
Issue number10
DOIs
StatePublished - Oct 2023
Externally publishedYes

Keywords

  • COVID-19
  • comorbidity
  • hospital outcomes
  • neurological
  • seizure

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