Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19: a UK-wide cross-sectional surveillance study.
Creators: name: Ross Russell, Amy L
name: Hardwick, Marc
name: Jeyanantham, Athavan
name: White, Laura M
name: Deb, Saumitro
name: Burnside, Girvan
name: Joy, Harriet M
name: Smith, Craig J
name: Pollak, Thomas A
name: Nicholson, Timothy R
name: Davies, Nicholas W S
name: Manji, Hadi
name: Easton, Ava
name: Ray, Stephen
name: Zandi, Michael S
name: Coles, Jonathan P
name: Menon, David K
name: Varatharaj, Aravinthan
name: McCausland, Beth
name: Ellul, Mark A
name: Thomas, Naomi
name: Breen, Gerome
name: Keddie, Stephen
name: Lunn, Michael P
name: Burn, John P S
name: Quattrocchi, Graziella
name: Dixon, Luke
name: Rice, Claire M
name: Pengas, George
name: Al-Shahi Salman, Rustam
name: Carson, Alan
name: Joyce, Eileen M
name: Turner, Martin R
name: Benjamin, Laura A
name: Solomon, Tom
name: Kneen, Rachel
name: Pett, Sarah
name: Thomas, Rhys H
name: Michael, Benedict D
name: Galea, Ian
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: Stroke
Neurology
encephalopathy
Covid-19
Sars-cov-2

description: SARS-CoV-2 is associated with new-onset neurological and psychiatric conditions. Detailed clinical data, including factors associated with recovery, are lacking, hampering prediction modelling and targeted therapeutic interventions. In a UK-wide cross-sectional surveillance study of adult hospitalized patients during the first COVID-19 wave, with multi-professional input from general and sub-specialty neurologists, psychiatrists, stroke physicians, and intensivists, we captured detailed data on demographics, risk factors, pre-COVID-19 Rockwood frailty score, comorbidities, neurological presentation and outcome. <i>A priori</i> clinical case definitions were used, with cross-specialty independent adjudication for discrepant cases. Multivariable logistic regression was performed using demographic and clinical variables, to determine the factors associated with outcome. A total of 267 cases were included. Cerebrovascular events were most frequently reported (131, 49%), followed by other central disorders (95, 36%) including delirium (28, 11%), central inflammatory (25, 9%), psychiatric (25, 9%), and other encephalopathies (17, 7%), including a severe encephalopathy (<i>n</i> = 13) not meeting delirium criteria; and peripheral nerve disorders (41, 15%). Those with the severe encephalopathy, in comparison to delirium, were younger, had higher rates of admission to intensive care and a longer duration of ventilation. Compared to normative data during the equivalent time period prior to the pandemic, cases of stroke in association with COVID-19 were younger and had a greater number of conventional, modifiable cerebrovascular risk factors. Twenty-seven per cent of strokes occurred in patients &lt;60 years. Relative to those &gt;60 years old, the younger stroke patients presented with delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion (31%) and systemic thrombotic events. Clinical outcomes varied between disease groups, with cerebrovascular disease conferring the worst prognosis, but this effect was less marked than the pre-morbid factors of older age and a higher pre-COVID-19 frailty score, and a high admission white cell count, which were independently associated with a poor outcome. In summary, this study describes the spectrum of neurological and psychiatric conditions associated with COVID-19. In addition, we identify a severe COVID-19 encephalopathy atypical for delirium, and a phenotype of COVID-19 associated stroke in younger adults with a tendency for multiple infarcts and systemic thromboses. These clinical data will be useful to inform mechanistic studies and stratification of patients in clinical trials.