A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications.

Activities of Daily Living COVID-19 Humans Prospective Studies Quality of Life SARS-CoV-2

Anxiety Brain COVID-19 Cognitive Depression Fatigue Function Long-COVID Long-hauler Neurologic Outcomes Post-COVID syndrome Post-acute sequelae of COVID Quality of life Readmission SARS-CoV-2 Sleep

Journal

Journal of the neurological sciences

ISSN: 1878-5883

Titre abrégé: J Neurol Sci

Pays: Netherlands

ID NLM: 0375403

Informations de publication

Date de publication:
15 Jul 2021

Historique:

received: 25 02 2021

revised: 15 04 2021

accepted: 10 05 2021

pubmed: 18 5 2021

medline: 16 6 2021

entrez: 17 5 2021

Statut: ppublish

Résumé

Little is known regarding long-term outcomes of patients hospitalized with COVID-19. We conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep. Of 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N = 196 neurological patients and N = 186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 1.98, 95%CI 1.23-3.48, P = 0.02), worse ADLs (aOR 0.38, 95%CI 0.29-0.74, P = 0.01) and were less likely to return to work than controls (41% versus 64%, P = 0.04). Cognitive and Neuro-QOL metrics were similar between groups. Abnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.

Sections du résumé

BACKGROUND BACKGROUND

Little is known regarding long-term outcomes of patients hospitalized with COVID-19.

METHODS METHODS

We conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep.

RESULTS RESULTS

Of 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N = 196 neurological patients and N = 186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 1.98, 95%CI 1.23-3.48, P = 0.02), worse ADLs (aOR 0.38, 95%CI 0.29-0.74, P = 0.01) and were less likely to return to work than controls (41% versus 64%, P = 0.04). Cognitive and Neuro-QOL metrics were similar between groups.

CONCLUSIONS CONCLUSIONS

Abnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.

Identifiants

DOI: 10.1016/j.jns.2021.117486 PMID: 34000678 PMC: PMC8113108

pubmed: 34000678

pii: S0022-510X(21)00180-5

doi: 10.1016/j.jns.2021.117486

pmc: PMC8113108

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

117486

Subventions

Organisme : NIA NIH HHS

ID : P30 AG066512

Pays : United States

Informations de copyright

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