Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

Bhagteshwar Singh; Suzannah Lant; Sofia Cividini; Jonathan W. S. Cattrall; Lynsey C. Goodwin; Laura Benjamin; Benedict D. Michael; Ayaz Khawaja; Aline de Moura Brasil Matos; Walid Alkeridy; Andrea Pilotto; Durjoy Lahiri; Rebecca Rawlinson; Sithembinkosi Mhlanga; Evelyn C. Lopez; Brendan F. Sargent; Anushri Somasundaran; Arina Tamborska; Glynn Webb; Komal Younas; Yaqub Al Sami; Heavenna Babu; Tristan Banks; Francesco Cavallieri; Matthew Cohen; Emma Davies; Shalley Dhar; Anna Fajardo Modol; Hamzah Farooq; Jeffrey Harte; Samuel Hey; Albert Joseph; Dileep Karthikappallil; Daniel Kassahun; Gareth Lipunga; Rachel Mason; Thomas Minton; Gabrielle Mond; Joseph Poxon; Sophie Rabas; Germander Soothill; Marialuisa Zedde; Konstantin Yenkoyan; Bruce Brew; Erika Contini; Lucette Cysique; Xin Zhang; Pietro Maggi; Vincent van Pesch; Jerome Lechien; Sven Saussez; Alex Heyse; Maria Lucia Brito Ferreira; Cristiane N. Soares; Isabel Elicer; Laura Eugenin-von Bernhardi; Waleng Nancupil Reyes; Rong Yin; Mohammed A. Azab; Foad Abd-Allah; Ahmed Elkady; Simon Escalard; Jean-Christophe Corvol; Cecile Delorme; Pierre Tattevin; Kevin Bigaut; Norbert Lorenz; Daniel Hornuss; Jonas Hosp; Siegbert Rieg; Dirk Wagner; Benjamin Knier; Paul Lingor; Andrea Sylvia Winkler; Athena Sharifi-Razavi; Shima T. Moein; SeyedAhmad SeyedAlinaghi; Saeidreza JamaliMoghadamSiahkali; Mauro Morassi; Alessandro Padovani; Marcello Giunta; Ilenia Libri; Simone Beretta; Sabrina Ravaglia; Matteo Foschi; Paolo Calabresi; Guido Primiano; Serenella Servidei; Nicola Biagio Mercuri; Claudio Liguori; Mariangela Pierantozzi; Loredana Sarmati; Federica Boso; Silvia Garazzino; Sara Mariotto; Kimani N. Patrick; Oana Costache; Alexander Pincherle; Frederikus A. Klok; Roger Meza; Veronica Cabreira; Sofia R. Valdoleiros; Vanessa Oliveira; Igor Kaimovsky; Alla Guekht; Jasmine Koh; Eva Fernandez Diaz; Jose Maria Barrios-Lopez; Cristina Guijarro-Castro; Alvaro Beltran-Corbellini; Javier Martinez-Poles; Alba Maria Diezma-Martin; Maria Isabel Morales-Casado; Sergio Garcia Garcia; Gautier Breville; Matteo Coen; Marjolaine Uginet; Raphael Bernard-Valnet; Renaud Du Pasquier; Yildiz Kaya; Loay H. Abdelnour; Claire Rice; Hamish Morrison; Sylviane Defres; Saif Huda; Noelle Enright; Jane Hassell; Lucio D'Anna; Matthew Benger; Laszlo Sztriha; Eamon Raith; Krishna Chinthapalli; Ross Nortley; Ross Paterson; Arvind Chandratheva; David J. Werring; Samir Dervisevic; Kirsty Harkness; Ashwin Pinto; Dinesh Jillella; Scott Beach; Kulothungan Gunasekaran; Ivan Rocha Ferreira Da Silva; Krishna Nalleballe; Jonathan Santoro; Tyler Scullen; Lora Kahn; Carla Y. Kim; Kiran T. Thakur; Rajan Jain; Thirugnanam Umapathi; Timothy R. Nicholson; James J. Sejvar; Eva Maria Hodel; Catrin Tudur Smith; Tom Solomon; Brain Infect Global COVID-Neuro Ne

doi:10.1371/journal.pone.0263595

Back

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

Journal article

Open access

Peer reviewed

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

Bhagteshwar Singh, Suzannah Lant, Sofia Cividini, Jonathan W. S. Cattrall, Lynsey C. Goodwin, Laura Benjamin, Benedict D. Michael, Ayaz Khawaja, Aline de Moura Brasil Matos, Walid Alkeridy, …

PloS one, Vol.17(6), pp.e0263595-e0263595

02/06/2022

DOI: https://doi.org/10.1371/journal.pone.0263595

PMID: 35653330

Abstract

Multidisciplinary Sciences

Science & Technology

Science & Technology - Other Topics

Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67-82]), than encephalopathy (54% [42-65]). Intensive care use was high (38% [35-41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27-32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.

Files and links (1)

url

https://doi.org/10.1371/journal.pone.0263595View

Published (Version of record) Open

Metrics

1 Record Views

See more details

Details

Title: Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis
Creators - without role: Bhagteshwar Singh - University of Liverpool
Suzannah Lant - University of Liverpool
Sofia Cividini - University of Liverpool
Jonathan W. S. Cattrall - University of Liverpool
Lynsey C. Goodwin - University of Liverpool
Laura Benjamin - UCL, Queen Sq Inst Neurol, London, England
Benedict D. Michael - University of Liverpool
Ayaz Khawaja - Wayne State University
Aline de Moura Brasil Matos - College Station Medical Center
Walid Alkeridy - King Saud University
Andrea Pilotto - University of Brescia
Durjoy Lahiri - College Station Medical Center
Rebecca Rawlinson - University of Liverpool
Sithembinkosi Mhlanga - University of Liverpool
Evelyn C. Lopez - University of Liverpool
Brendan F. Sargent - University of Liverpool
Anushri Somasundaran - University of Liverpool
Arina Tamborska - University of Liverpool
Glynn Webb - University of Liverpool
Komal Younas - University of Liverpool
Yaqub Al Sami - Homerton Univ Hosp NHS Fdn Trust, London, England
Heavenna Babu - Natl Inst Mental Hlth & Neurosci, Dept Neurovirol, Bangalore, Karnataka, India
Tristan Banks - Manchester Univ NHS Fdn Trust, Dept Infect, Manchester, Lancs, England
Francesco Cavallieri - Azienda USL IRCCS Reggio Emilia, Neurol Unit, Neuromotor & Rehabil Dept, Reggio Emilia, Italy
Matthew Cohen - Liverpool Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England
Emma Davies - Manchester Univ NHS Fdn Trust, Dept Virol, UK Hlth Secur Agcy, Manchester, Lancs, England
Shalley Dhar - Natl Inst Mental Hlth & Neurosci, Dept Neurovirol, Bangalore, Karnataka, India
Anna Fajardo Modol - University of Liverpool
Hamzah Farooq - Manchester Univ NHS Fdn Trust, Dept Virol, UK Hlth Secur Agcy, Manchester, Lancs, England
Jeffrey Harte - Barts Hlth NHS Trust, London, England
Samuel Hey - Manchester Univ Fdn NHS Trust, North Manchester Gen Hosp, Dept Infect Dis & Trop Med, Manchester, Lancs, England
Albert Joseph - Homerton Univ Hosp NHS Fdn Trust, London, England
Dileep Karthikappallil - Liverpool Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England
Daniel Kassahun - Warrington & Halton Teaching Hosp NHS Fdn Trust, Warrington Hosp, Warrington, Cheshire, England
Gareth Lipunga - Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Rachel Mason - Kingston Hosp NHS Fdn Trust, Kingston Upon Thames, Surrey, England
Thomas Minton - University of Bristol
Gabrielle Mond - Manchester Univ Fdn NHS Trust, North Manchester Gen Hosp, Manchester, Lancs, England
Joseph Poxon - Epsom & St Helier Univ Hosp NHS Fdn Trust, London, England
Sophie Rabas - Kings Coll Hosp NHS Fdn Trust, London, England
Germander Soothill - NHS Lothian
Marialuisa Zedde - Azienda USL IRCCS Reggio Emilia, Neurol Unit, Neuromotor & Rehabil Dept, Reggio Emilia, Italy
Konstantin Yenkoyan - College Station Medical Center
Bruce Brew - St Vincents Hosp, Sydney, NSW, Australia
Erika Contini - St Vincents Hosp, Sydney, NSW, Australia
Lucette Cysique - St Vincents Hosp, Sydney, NSW, Australia
Xin Zhang - St Vincents Hosp, Sydney, NSW, Australia
Pietro Maggi - St Luc Univ Hosp, Brussels, Belgium
Vincent van Pesch - St Luc Univ Hosp, Brussels, Belgium
Jerome Lechien - University of Mons
Sven Saussez - University of Mons
Alex Heyse - AZ Glorieux, Ronse, Belgium
Maria Lucia Brito Ferreira - Hosp Restauracao, Recife, PE, Brazil
Cristiane N. Soares - Hosp Fed Serv Estado, Rio De Janeiro, Brazil
Isabel Elicer - Hosp Dr Sotero del Rio, Santiago, Chile
Laura Eugenin-von Bernhardi - Hosp Dr Sotero del Rio, Santiago, Chile
Waleng Nancupil Reyes - University of Chile
Rong Yin - 940th Hosp Joint Logist Support Force Peoples Lib, Lanzhou, Peoples R China
Mohammed A. Azab - Cairo University
Foad Abd-Allah - Kasr Alainy Teaching Hosp, Cairo, Egypt
Ahmed Elkady - Mataria Teaching Hosp, Cairo, Egypt
Simon Escalard - Fondation Ophtalmologique Adolphe de Rothschild
Jean-Christophe Corvol - Pitié-Salpêtrière Hospital
Cecile Delorme - Hop La Pitie Salpetriere, Paris, France
Pierre Tattevin - Hôpital Pontchaillou
Kevin Bigaut - Hôpitaux Universitaires de Strasbourg
Norbert Lorenz - Dresden Municipal Hosp Teaching Hosp TUD, Childrens Hosp, Dresden, Germany
Daniel Hornuss - University of Freiburg
Jonas Hosp - University of Freiburg
Siegbert Rieg - University of Freiburg
Dirk Wagner - University of Freiburg
Benjamin Knier - Tech Univ Munich, Dept Neurol, Munich, Germany
Paul Lingor - Tech Univ Munich, Dept Neurol, Munich, Germany
Andrea Sylvia Winkler - Tech Univ Munich, Dept Neurol, Munich, Germany
Athena Sharifi-Razavi - College Station Medical Center
Shima T. Moein - Inst Res Fundamental Sci IPM, Tehran, Iran
SeyedAhmad SeyedAlinaghi - University of Tehran
Saeidreza JamaliMoghadamSiahkali - University of Tehran
Mauro Morassi - Fdn Poliambulanza Ist Osped, Brescia, Italy
Alessandro Padovani - University of Brescia
Marcello Giunta - University of Brescia
Ilenia Libri - University of Brescia
Simone Beretta - University of Milano-Bicocca
Sabrina Ravaglia - Fdn Mondino IRCCS, Pavia, Italy
Matteo Foschi - AUSL Romagna, Santa Maria Croci Hosp, Ravenna, Italy
Paolo Calabresi - Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy
Guido Primiano - Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy
Serenella Servidei - Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy
Nicola Biagio Mercuri - Univ Hosp Rome Tor Vergata, Rome, Italy
Claudio Liguori - Univ Hosp Rome Tor Vergata, Rome, Italy
Mariangela Pierantozzi - Univ Hosp Rome Tor Vergata, Rome, Italy
Loredana Sarmati - Univ Hosp Rome Tor Vergata, Rome, Italy
Federica Boso - Healthcare Trust Autonomous Reg Trento, Rovereto, Italy
Silvia Garazzino - Regina Margherita Childrens Hosp, Citta Salute & Sci Torino, Turin, Italy
Sara Mariotto - University of Verona
Kimani N. Patrick - Halcyon Healthcare Ltd, Nairobi, Kenya
Oana Costache - Hop Robert Schuman, Luxembourg, Luxembourg
Alexander Pincherle - Hop Robert Schuman, Luxembourg, Luxembourg
Frederikus A. Klok - Leiden University
Roger Meza - Hosp Reg Docente Trujillo, Trujillo, Peru
Veronica Cabreira - Ctr Hosp Sao Joao, Porto, Portugal
Sofia R. Valdoleiros - Universidade do Porto
Vanessa Oliveira - Universidade do Porto
Igor Kaimovsky - Buyanov Moscow City Hosp, Moscow, Russia
Alla Guekht - Buyanov Moscow City Hosp, Moscow, Russia
Jasmine Koh - Natl Neurosci Inst, Singapore, Singapore
Eva Fernandez Diaz - Complejo Hosp Univ Albacete, Albacete, Spain
Jose Maria Barrios-Lopez - Hosp Univ Virgen de las Nieves, Granada, Spain
Cristina Guijarro-Castro - Univ Hosp Sanchinarro, Madrid, Spain
Alvaro Beltran-Corbellini - Univ Hosp Ramon y Cajal, Madrid, Spain
Javier Martinez-Poles - Univ Hosp Ramon y Cajal, Madrid, Spain
Alba Maria Diezma-Martin - Hosp Virgen Salud, Toledo, Spain
Maria Isabel Morales-Casado - Hosp Virgen Salud, Toledo, Spain
Sergio Garcia Garcia - Hosp Rio Hortega, Valladolid, Spain
Gautier Breville - Hop Univ Geneve, Geneva, Switzerland
Matteo Coen - Hop Univ Geneve, Geneva, Switzerland
Marjolaine Uginet - Hop Univ Geneve, Geneva, Switzerland
Raphael Bernard-Valnet - CHU Vaudois, Lausanne, Switzerland
Renaud Du Pasquier - CHU Vaudois, Lausanne, Switzerland
Yildiz Kaya - Supreme Council Of Health
Loay H. Abdelnour - Ulster Hosp, Belfast, Antrim, North Ireland
Claire Rice - University of Bristol
Hamish Morrison - Gloucestershire Royal Hosp, Gloucester, England
Sylviane Defres - Liverpool Univ Hosp NHS Fdn Trust, Trop & Infect Dis Unit, Liverpool, Merseyside, England
Saif Huda - Walton Ctr NHS Fdn Trust, Liverpool, Merseyside, England
Noelle Enright - Ormond
Jane Hassell - Ormond
Lucio D'Anna - Imperial Coll London, London, England
Matthew Benger - Kings Coll Hosp NHS Fdn Trust, London, England
Laszlo Sztriha - Kings Coll Hosp NHS Fdn Trust, London, England
Eamon Raith - Natl Hosp Neurol & Neurosurg, London, England
Krishna Chinthapalli - UCL, London, England
Ross Nortley - UCL, London, England
Ross Paterson - UCL, London, England
Arvind Chandratheva - UCL, Queen Sq Inst Neurol, London, England
David J. Werring - UCL, Queen Sq Inst Neurol, London, England
Samir Dervisevic - Norwich University
Kirsty Harkness - Sheffield Teaching Hosp Trust, Sheffield, S Yorkshire, England
Ashwin Pinto - Wessex Neurol Ctr, Southampton, Hants, England
Dinesh Jillella - Emory University
Scott Beach - Supreme Council Of Health
Kulothungan Gunasekaran - Yale New Haven Hlth Bridgeport Hosp, Bridgeport, CT USA
Ivan Rocha Ferreira Da Silva - Rush University
Krishna Nalleballe - College Station Medical Center
Jonathan Santoro - Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA
Tyler Scullen - College Station Medical Center
Lora Kahn - College Station Medical Center
Carla Y. Kim - Columbia University
Kiran T. Thakur - Columbia University
Rajan Jain - Supreme Council Of Health
Thirugnanam Umapathi - Natl Neurosci Inst, Dept Neurol, Singapore, Singapore
Timothy R. Nicholson - Kings Coll London, Inst Psychiat Psychol & Neurosci, London, England
James J. Sejvar - Ctr Dis Control & Prevent, Div High Consequence Pathogens & Pathol, Natl Ctr Emerging & Zoonot Infect Dis, Atlanta, GA USA
Eva Maria Hodel - University of Liverpool
Catrin Tudur Smith - University of Liverpool
Tom Solomon - University of Liverpool
Brain Infect Global COVID-Neuro Ne
Publication Details: PloS one, Vol.17(6), pp.e0263595-e0263595
Publisher: Public Library Science
Number of pages: 26
Grant note: MR/V033441/1 / UK Medical Research Council's Global Effort on COVID-19 Programme NIHR200907; IS-HPU-1112-10117 / University of Oxford NIHR200907 / NIHR Health ProtectionResearch Unit in Emerging and Zoonotic Infections at University of Liverpool 17/63/110 / UK National Institute for Health Research (NIHR); National Institutes of Health Research (NIHR) Public Health England (PHE) Liverpool School of Tropical Medicine
Identifiers: 9949981108331
Academic Unit: King Saud University
Language: English
Resource Type: Journal article