Neurological Manifestations in COVID-19 patients Linked to Poor Long-Term Outcomes, claims study

The study aimed to shed light on the association between neurological involvement and post-discharge morbidity and mortality. Acute neurological manifestations are increasingly recognized as complications of COVID-19, affecting a considerable proportion of patients. However, the long-term implications of these neurological symptoms remain unclear.

Researchers analyzed data from patients admitted for COVID-19 at the Montefiore Health System in the Bronx, New York, during the early stages of the pandemic. A total of 414 patients with significant neurological manifestations were compared with 1,199 propensity-matched patients without such manifestations. Follow-up data were collected over a 3-year period to assess outcomes.

The key findings of the study were as follows:

• Demographic characteristics were similar between the two cohorts, with no significant differences in sex distribution and ICU status. However, the neurological cohort had a higher proportion of black non-Hispanic patients.

• Patients with neurological manifestations experienced higher rates of adverse outcomes post-discharge. This included increased mortality, stroke, major adverse cardiovascular events (MACE), and hospital readmission.

• Mortality was significantly elevated in the neurological cohort compared to controls (hazard ratio: 2.346, p < 0.001).

• Neurological cohort patients were more frequently discharged to acute rehabilitation or skilled nursing facilities and less often discharged home.

• They exhibited higher incidences of stroke, MACE, and readmission post-discharge.

• Several factors were associated with increased mortality post-discharge, including neurological manifestations, discharge disposition, congestive heart failure, higher COVID-19 severity score, and older age.

• While both cohorts showed similar rates of radiological abnormalities, the neurological cohort exhibited significantly more age-adjusted brain volume loss.

The study's findings highlight the profound impact of neurological involvement on the trajectory of COVID-19 illness. Patients with significant neurological manifestations faced a multitude of challenges, including higher rates of readmission, cardiovascular events, and mortality even after discharge from the hospital. These results underscore the importance of considering neurological symptoms as crucial markers of disease severity and prognosis in COVID-19 patients.

This study provides compelling evidence of the detrimental impact of neurological manifestations on the long-term outcomes of COVID-19 patients. By recognizing the significance of neurological involvement in COVID-19, healthcare providers can better anticipate and address the complex needs of affected individuals, ultimately improving patient care and clinical outcomes.

Reference:

Eligulashvili, A., Gordon, M., Lee, J. S., Lee, J., Mehrotra-Varma, S., Mehrotra-Varma, J., Hsu, K., Hilliard, I., Lee, K., Li, A., Essibayi, M. A., Yee, J., Altschul, D. J., Eskandar, E., Mehler, M. F., & Duong, T. Q. (2024). Long-term outcomes of hospitalized patients with SARS-CoV-2/COVID-19 with and without neurological involvement: 3-year follow-up assessment. PLoS Medicine, 21(4), e1004263. https://doi.org/10.1371/journal.pmed.1004263