Long-Term Abnormalities Observed in Hospitalized Patients With COVID-19

Jennifer Frontera, MD

Data from a prospective 6-month study evaluating patients discharged for COVID-19 demonstrated that more than 90% of patients experienced abnormalities in functional outcomes, activities of daily living (ADL), anxiety, depression, and sleep. Patients diagnosed with new neurological complications during hospitalization had a 2-fold increased odds of worse 6-month functional outcome.^1,2

Lead author Jennifer Frontera, MD, professor of neurology, NYU Langone Grossman School of Medicine, and colleagues used multivariable ordinal analysis of the modified Rankin Scale (mRS) as the primary 6-month outcome to compare patients with COVID-19 both with (n = 196) and without neurological complications (n = 186). The median age of patients with neurological complications was 68 years compared to 69 years for those without neurological events (P = .388).

At the end of the 6-month period, 91% (346 of 382) of patients experienced at least 1 abnormal outcome. Of them, 56% (170 of 304) had limited ADL, 50% (106 of 215) had impaired cognition, and 47% (81 of 154) of those working pre-morbidity were unable to work at 6 months. Between discharge and 6 months, 20% (40 of 196) of neurological patients and 19% (35 of 186) of the control group died (P = .715).¹

"Although we thought going in that patients with neurological complications would have worse long-term outcomes, which turned out to be the case, we also found that both groups had very high rates of cognitive impairment at 6 months,” Frontera said in a statement.²

READ MORE: Seizure Exacerbation Not Observed in People With Epilepsy and COVID-19

Patients with neurological complications had a median mRS score of 4 (interquartile range [IQR], 2-5) compared to median scores of 3 (IQR, 1-4; unadjusted ordinal logistic regression analysis odds ratio [OR], 1.57 [95% CI, 1.10-2.24]) in controls. The occurrence of new neurological complications during COVID-19 hospitalization remained a significant independent predictor of worse 6-month mRS scores (adjusted OR, 1.98 [95% CI, 1.23-3.48]; P = .02). Older age, worse baseline functional status, and longer hospital length of stay were also identified as other significant predictors of worse scores at 6 months.

In total, 53% of patients with neurological complications were more likely to have impaired ADL as measured by the Barthel Index, compared to 35% of controls (Chi-squared test P = .002). These same patients were also less likely to return to work (41% versus 64% of controls; Chi-squared test P = .004).

Between both groups, researchers saw similar T-scores on Quality of Life in Neurological Disorders (Neuro-QoL), a short form self-reported assessment of anxiety, depression, fatigue, and sleep. Among the 280 of those who completed the assessment, 62% (n = 174) demonstrated worse than average scores compared to reference populations on at least 1 metric: 46% (n = 128) scored worse than average on anxiety; 38% (105 of 278) on sleep; 36% (98 of 272) on fatigue, and 25% (71 of 279) on depression.

The most common diagnoses within the neurological complications cohort were toxic-metabolic encephalopathy (52%), hypoxic-ischemic encephalopathy (21%), stroke (11%), and seizure (11%). Hospital readmission occurred in 14% of patients in both groups. Persistent dyspnea severe enough to limit normal activity occurred in 35% of all patients and did not differ between groups.

"This is the first study, to our knowledge, to assess long-term neurological function among COVID-19 hospital survivors in a standardized fashion using a variety of outcome measures,” senior author Steven L. Galetta, MD, chair, Department of Neurology, NYU Langone, said in a statement.² “The frequency and severity of functional, cognitive, and mood abnormalities among COVID-19 hospital survivors—with and without original neurological complications—should shape educational and preventive efforts going forward.”

Frontera has been at the forefront of the pandemic, having experience both on the front lines and in the research space. In October 2020, she sat down with NeurologyLive to provide her thoughts on the growing amount of data regarding the virus, and the increased new neurological complications being observed. Watch her share her thoughts in the video below.

REFERENCES

1. Frontera JA, Yang D, Lewis A, et al. A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications. J Neurol Sci. Published online May 11, 2021. doi: 10.1016/j.jns.2021.117486

2. Most COVID-19 patients have long-term neurological problems. News release. NYU Langone. May 18, 2021. Accessed May 27, 2021. https://nyulangone.org/news/most-covid-19-patients-have-long-term-neurological-problems