82% of People Hospitalized With COVID-19 Develop Neurological Problems

Computer tomography of the brain.

According to an interim analysis of the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID), patients with clinically diagnosed neurological symptoms associated with COVID-19 are six times more likely to die in hospital than those without the neurological complications. .

An article published today (May 11, 2021) in JAMA Network Open presents the first results of the global effort to collect information on the incidence, severity and outcomes of neurological manifestations of COVID-19 disease.

“Very early on during the pandemic, it became apparent that a large number of people who were ill enough to be hospitalized also develop neurological problems,” said lead author Sherry Chou, MD, M.Sc., the consortium’s lead investigator and collaborator. professor of intensive care medicine, neurology and neurosurgery at the University of Pittsburgh School of Medicine and UPMC. “A year later we are still fighting an unknown invisible enemy and, as in any battle, we need information – we need to learn as much as possible about the neurological consequences of COVID-19 in patients who are actively ill and in survivors. “

Principal Investigator of the Global Consortium Study of Neurologic Dysfunction in COVID-19, Associate Professor of Intensive Care Medicine, Neurology and Neurosurgery, University of Pittsburgh School of Medicine and UPMC, and Associate Director of the Pitt Safar Center for Resuscitation Research. Credit: Sherry Chou

The GCS-NeuroCOVID is the largest cohort study of neurological manifestations of COVID-19 to date, spanning 133 adult patient sites on all continents except Antarctica.

Of a group of 3,744 adult patients with COVID-19 in hospital, 82% had self-reported or clinically recorded neurological symptoms. Almost 4 in 10 patients reported having a headache, and about 3 in 10 said they lost their sense of smell or taste. Of the clinically diagnosed syndromes – abnormalities that a doctor can observe at the bedside, regardless of whether the patient is aware of the problem – acute encephalopathy was the most common, in nearly half of the patients, followed by coma (17%) and strokes (6%). ).

Despite early concerns about the coronavirus’ ability to directly attack the brain and cause brain swelling and inflammation – meningitis and encephalitis – these events were very rare and occurred in less than 1% of hospitalized COVID -19 patients.

“Acute encephalopathy is by far the most common symptom we see in the clinic,” said Chou, also deputy director of the Pitt Safar Center for Resuscitation Research. “Those patients may be in an altered sensory state or have decreased consciousness, or they may no longer feel themselves and behave confused, delirious, or agitated.”

The researchers analyzed data from three different types of patient cohorts – the “all COVID-19” cohort, which included all 3,055 hospitalized patients with COVID-19, regardless of their neurological status; the “neurological” cohort, which included 475 admitted COVID-19 patients with clinically confirmed neurological symptoms, assembled by the GCS-NeuroCOVID consortium; and the “ENERGY” cohort, or 214 hospitalized COVID-19 patients to be evaluated by a neurologist and who were authorized to participate in the European Academy of Neurology Neuro-COVID Registry (ENERGY), a formal partner of the GCS-NeuroCOVID Consortium.

The study found that having a pre-existing neurological condition of any kind – from brain, spinal, and nervous disorders to chronic migraines, dementia, or Alzheimer’s – is the strongest predictor of developing COVID-19. related neurological complications, which are increasing. the risk is twofold. In addition, having neurological symptoms related to COVID-19 – from something as harmless as the loss of smell to major events like strokes – is associated with a six times higher risk of death.

But even if a patient beats the odds and recovers, their long-term health outlook is still uncertain.

“Even if the pandemic is completely eradicated, we are still talking about millions of survivors who need our help,” Chou said. “It is important to find out what symptoms and health problems patients are facing, and there is still years of work to be done.”

Reference: May 11, 2021, JAMA Network Open.
DOI: 10.1001 / jamanetworkopen.2021.12131

Other authors of the study include Valeria Altamirano, MS, of Pitt; Ettore Beghi, MD, from Istituto di Ricerche Pharmacologiche Mario Negri IRCCS, Milan, Italy; Raimund Helbok, MD, of the Medical University of Innsbruck, Austria; Elena Moro, MD, Ph.D., from Grenoble Institute of Neuroscience, France; Joshua Sampson, Ph.D., of the National Cancer Institute, Baltimore; Shraddha Mainali, MD, and Molly McNett, Ph.D., of Ohio State University, Columbus, Ohio; Claudio Bassetti, MD, from the University of Bern, Switzerland; Jose Suarez, MD, of Johns Hopkins University School of Medicine, Baltimore; and other members of the GCS-NeuroCOVID Consortium and ENERGY Consortium. The GCS-NeuroCOVID consortium is endorsed by the Neurocritical Care Society.

Authors thank the Pitt School of Medicine research team, including the GCS-NeuroCOVID Consortium Coordinator Ali Scott-Smith, volunteer Pitt neurology residents, Pitt medical students, and undergraduate students.

This research was supported by the National Institutes of Health (grant R21NS113037), National Center for Advancing Translational Sciences (grant UL1TR001857), and the University of Pittsburgh Dean’s Faculty Advancement Award.