Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19—A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium
Authors: Sherry H.-Y. Chou, Ettore Beghi, Raimund Helbok, Elena Moro, Joshua Sampson, Valeria Altamirano, Shraddha Mainali, Claudio Bassetti, Jose I. Suarez, Molly McNett, Lawrence Nolan, Kristi Temro, Anna M. Cervantes-Arslanian, Pria Anand, Shibani Mukerji, Haitham Alabasi, M. Brandon Westover, Tapan Kavi, Sayona John, Ivan Da Silva, Arif Shaik, Aarti Sarwal, Saef Izzy, Eric M. Liotta, Ayush Batra, Aimee Aysenne, Clio Rubinos, Ahmed Y. Azzam, Mohammed A. Azab, Justin Sandall, LeighAnn M. Persondek, Hanno Ulmer, Verena Rass, Bettina Pfausler, Christoph Müller, Simon Jung, Michael Crean, Sara Meoni, Daniel Bereczki, Tibor              Kovács      , Netta Agajany, Carmel Armon, Sharon Wolfson, Maria Sofia Cotelli, Elisa Bianchi, Anis Riahi, Serefnur Öztürk, Onur Ural, Gryb Viktoriia, Mariana Lesiv, Luis Maia, Vanessa Oliveira, Mafalda Seabra, Vanessa Carvalho, Paul Vespa, Javier Provencio, Daiwai Olson, Claude Hemphill, Chethan P Venkatasubba Rao, Nerissa Ko, Ericka Fink, Courtney Robertson, Michelle Schober, Ali Smith Scott, Michal Hammond, Nicole Paul, Aleksandra Safonova, Lauren Kaplan, Charith Ratnayake, Adytia D Sharma, Abigail Skeel, Carlos Villamizar Rosales, Dominika Dolak, Panayiotis Varelas, Lev Lotman, Lalit Kaltenbach, Menon David K.
Journal: JAMA Network Open (2021)

<h3>Importance</h3> The COVID-19 pandemic continues to affect millions of people globally, with increasing reports of neurological manifestations but limited data on their incidence and associations with outcome. <h3>Objective</h3> To determine the neurological phenotypes, incidence, and outcomes among adults hospitalized with COVID-19. <h3>Design, Setting, and Participants</h3> This cohort study included patients with clinically diagnosed or laboratory-confirmed COVID-19 at 28 centers, representing 13 countries and 4 continents. The study was performed by the Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) from March 1 to September 30, 2020, and the European Academy of Neurology (EAN) Neuro-COVID Registry (ENERGY) from March to October 2020. Three cohorts were included: (1) the GCS-NeuroCOVID all COVID-19 cohort (n = 3055), which included consecutive hospitalized patients with COVID-19 with and without neurological manifestations; (2) the GCS-NeuroCOVID COVID-19 neurological cohort (n = 475), which comprised consecutive patients hospitalized with COVID-19 who had confirmed neurological manifestations; and (3) the ENERGY cohort (n = 214), which included patients with COVID-19 who received formal neurological consultation. <h3>Exposures</h3> Clinically diagnosed or laboratory-confirmed COVID-19. <h3>Main Outcomes and Measures</h3> Neurological phenotypes were classified as self-reported symptoms or neurological signs and/or syndromes assessed by clinical evaluation. Composite incidence was reported for groups with at least 1 neurological manifestation. The main outcome measure was in-hospital mortality. <h3>Results</h3> Of the 3055 patients in the all COVID-19 cohort, 1742 (57%) were men, and the mean age was 59.9 years (95% CI, 59.3-60.6 years). Of the 475 patients in the COVID-19 neurological cohort, 262 (55%) were men, and the mean age was 62.6 years (95% CI, 61.1-64.1 years). Of the 214 patients in the ENERGY cohort, 133 (62%) were men, and the mean age was 67 years (95% CI, 52-78 years). A total of 3083 of 3743 patients (82%) across cohorts had any neurological manifestation (self-reported neurological symptoms and/or clinically captured neurological sign and/or syndrome). The most common self-reported symptoms included headache (1385 of 3732 patients [37%]) and anosmia or ageusia (977 of 3700 patients [26%]). The most prevalent neurological signs and/or syndromes were acute encephalopathy (1845 of 3740 patients [49%]), coma (649 of 3737 patients [17%]), and stroke (222 of 3737 patients [6%]), while meningitis and/or encephalitis were rare (19 of 3741 patients [0.5%]). Presence of clinically captured neurologic signs and/or syndromes was associated with increased risk of in-hospital death (adjusted odds ratio [aOR], 5.99; 95% CI, 4.33-8.28) after adjusting for study site, age, sex, race, and ethnicity. Presence of preexisting neurological disorders (aOR, 2.23; 95% CI, 1.80-2.75) was associated with increased risk of developing neurological signs and/or syndromes with COVID-19. <h3>Conclusions and Relevance</h3> In this multicohort study, neurological manifestations were prevalent among patients hospitalized with COVID-19 and were associated with higher in-hospital mortality. Preexisting neurological disorders were associated with increased risk of developing neurological signs and/or syndromes in COVID-19.