Multinational characterization of neurological phenotypes in patients hospitalized with COVID-19
Authors: Le Trang T. , Gutiérrez-Sacristán Alba , Son Jiyeon , Hong Chuan , South Andrew M. , Beaulieu-Jones Brett K. , Loh Ne Hooi Will , Luo Yuan , Morris Michele , Ngiam Kee Yuan , Patel Lav P. , Samayamuthu Malarkodi J. , Schriver Emily , Tan Amelia L. M. , Moore Jason , Cai Tianxi , Omenn Gilbert S. , Avillach Paul , Kohane Isaac S. ,   The Consortium for Clinical Characterization of COVID-19 by EHR (4CE), Aaron James R. , Agapito Giuseppe , Albayrak Adem , Alessiani Mario , Amendola Danilo F. , Angoulvant François , Anthony Li L. L. J. , Aronow Bruce J. , Atz Andrew , Balshi James , Bell Douglas S. , Bellasi Antonio , Bellazzi Riccardo , Benoit Vincent , Beraghi Michele , Bernal Sobrino José Luis , Bernaux Mélodie , Bey Romain , Blanco Martínez Alvar , Boeker Martin , Bonzel Clara-Lea , Booth John , Bosari Silvano , Bourgeois Florence T. , Bradford Robert L. , Brat Gabriel A. , Bréant Stéphane , Brown Nicholas W. , Bryant William A. , Bucalo Mauro , Burgun Anita , Cannataro Mario , Carmona Aldo , Caucheteux Charlotte , Champ Julien , Chen Krista , Chen Jin , Chiovato Luca , Chiudinelli Lorenzo , Cimino James J. , Colicchio Tiago K. , Cormont Sylvie , Cossin Sébastien , Craig Jean B. , Cruz Bermúdez Juan Luis , Cruz Rojo Jaime , Dagliati Arianna , Daniar Mohamad , Daniel Christel , Davoudi Anahita , Devkota Batsal , Dubiel Julien , Esteve Loic , Fan Shirley , Follett Robert W. , Gaiolla Paula S. A. , Ganslandt Thomas , García Barrio Noelia , Garmire Lana X. , Gehlenborg Nils , Geva Alon , Gradinger Tobias , Gramfort Alexandre , Griffier Romain , Griffon Nicolas , Grisel Olivier , Hanauer David A. , Haverkamp Christian , He Bing , Henderson Darren W. , Hilka Martin , Holmes John H. , Horki Petar , Huling Kenneth M. , Hutch Meghan R. , Issitt Richard W. , Jannot Anne Sophie , Jouhet Vianney , Kavuluru Ramakanth , Keller Mark S. , Kirchoff Katie , Klann Jeffrey G. , Krantz Ian D. , Kraska Detlef , Krishnamurthy Ashok K. , L’Yi Sehi , Leblanc Judith , Leite Andressa R. R. , Lemaitre Guillaume , Lenert Leslie , Leprovost Damien , Liu Molei , Lozano-Zahonero Sarah , Lynch Kristine E. , Mahmood Sadiqa , Maidlow Sarah , Makoudjou Tchendjou Adeline C. , Malovini Alberto , Mandl Kenneth D. , Mao Chengsheng , Maram Anupama , Martel Patricia , Masino Aaron J. , Matheny Michael E. , Maulhardt Thomas , Mazzitelli Maria , McDuffie Michael T. , Mensch Arthur , Ashraf Fatima , Milano Marianna , Minicucci Marcos F. , Moal Bertrand , Moraleda Cinta , Morris Jeffrey S. , Moshal Karyn L. , Mousavi Sajad , Murad Douglas A. , Murphy Shawn N. , Naughton Thomas P. , Neuraz Antoine , Norman James B. , Obeid Jihad , Okoshi Marina P. , Olson Karen L. , Orlova Nina , Ostasiewski Brian D. , Palmer Nathan P. , Paris Nicolas , Pedrera Jimenez Miguel , Pfaff Emily R. , Pillion Danielle , Prokosch Hans U. , Prudente Robson A. , Quirós González Víctor , Ramoni Rachel B. , Raskin Maryna , Rieg Siegbert , Roig Domínguez Gustavo , Rojo Pablo , Sáez Carlos , Salamanca Elisa , Sandrin Arnaud , Santos Janaina C. C. , Savino Maria , Schuettler Juergen , Scudeller Luigia , Sebire Neil J. , Balazote Pablo Serrano , Serre Patricia , Serret-Larmande Arnaud , Shakeri Zahra , Silvio Domenick , Sliz Piotr , Sonday Charles , Spiridou Anastasia , Tan Bryce W. Q. , Tan Byorn W. L. , Tanni Suzana E. , Taylor Deanne M. , Terriza-Torres Ana I. , Tibollo Valentina , Tippmann Patric , Torti Carlo , Trecarichi Enrico M. , Tseng Yi-Ju , Vallejos Andrew K. , Varoquaux Gael , Vella Margaret , Vie Jill-Jênn , Vitacca Michele , Wagholikar Kavishwar B. , Waitman Lemuel R. , Wassermann Demian , Weber Griffin M. , William Yuan , Yehya Nadir , Zambelli Alberto , Zhang Harrison G. , Zoeller Daniela , Zucco Chiara , Visweswaran Shyam , Mowery Danielle L. , Xia Zongqi 
Published: October 2021

Neurological complications worsen outcomes in COVID-19. To define the prevalence of neurological conditions among hospitalized patients with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test in geographically diverse multinational populations during early pandemic, we used electronic health records (EHR) from 338 participating hospitals across 6 countries and 3 continents (January–September 2020) for a cross-sectional analysis. We assessed the frequency of International Classification of Disease code of neurological conditions by countries, healthcare systems, time before and after admission for COVID-19 and COVID-19 severity. Among 35,177 hospitalized patients with SARS-CoV-2 infection, there was an increase in the proportion with disorders of consciousness (5.8%, 95% confidence interval [CI] 3.7–7.8%, pFDR < 0.001) and unspecified disorders of the brain (8.1%, 5.7–10.5%, pFDR < 0.001) when compared to the pre-admission proportion. During hospitalization, the relative risk of disorders of consciousness (22%, 19–25%), cerebrovascular diseases (24%, 13–35%), nontraumatic intracranial hemorrhage (34%, 20–50%), encephalitis and/or myelitis (37%, 17–60%) and myopathy (72%, 67–77%) were higher for patients with severe COVID-19 when compared to those who never experienced severe COVID-19. Leveraging a multinational network to capture standardized EHR data, we highlighted the increased prevalence of central and peripheral neurological phenotypes in patients hospitalized with COVID-19, particularly among those with severe disease.