Multinational characterization of neurological phenotypes in patients hospitalized with COVID-19

Abstract

Neurological complications worsen outcomes in COVID-19. To define the prevalence of neurological conditions among hospitalized patients with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test in geographically diverse multinational populations during early pandemic, we used electronic health records (EHR) from 338 participating hospitals across 6 countries and 3 continents (January–September 2020) for a cross-sectional analysis. We assessed the frequency of International Classification of Disease code of neurological conditions by countries, healthcare systems, time before and after admission for COVID-19 and COVID-19 severity. Among 35,177 hospitalized patients with SARS-CoV-2 infection, there was an increase in the proportion with disorders of consciousness (5.8%, 95% confidence interval [CI] 3.7–7.8%, p FDR  < 0.001) and unspecified disorders of the brain (8.1%, 5.7–10.5%, p FDR  < 0.001) when compared to the pre-admission proportion. During hospitalization, the relative risk of disorders of consciousness (22%, 19–25%), cerebrovascular diseases (24%, 13–35%), nontraumatic intracranial hemorrhage (34%, 20–50%), encephalitis and/or myelitis (37%, 17–60%) and myopathy (72%, 67–77%) were higher for patients with severe COVID-19 when compared to those who never experienced severe COVID-19. Leveraging a multinational network to capture standardized EHR data, we highlighted the increased prevalence of central and peripheral neurological phenotypes in patients hospitalized with COVID-19, particularly among those with severe disease.

Citation

TT Le, A Gutiérrez-Sacristán, J Son, C Hong, AM South, BK Beaulieu-Jones, NHW Loh, Y Luo, M Morris, KY Ngiam, LP Patel, MJ Samayamuthu, E Schriver, ALM Tan, J Moore, T Cai, GS Omenn, P Avillach, IS Kohane, The Consortium for Clinical Characterization of COVID-19 by EHR (4CE), JR Aaron, G Agapito, A Albayrak, M Alessiani, DF Amendola, F Angoulvant, LLLJ Anthony, BJ Aronow, A Atz, J Balshi, DS Bell, A Bellasi, R Bellazzi, V Benoit, M Beraghi, JL Bernal Sobrino, M Bernaux, R Bey, A Blanco Martínez, M Boeker, CL Bonzel, J Booth, S Bosari, FT Bourgeois, RL Bradford, GA Brat, S Bréant, NW Brown, WA Bryant, M Bucalo, A Burgun, M Cannataro, A Carmona, C Caucheteux, J Champ, K Chen, J Chen, L Chiovato, L Chiudinelli, JJ Cimino, TK Colicchio, S Cormont, S Cossin, JB Craig, JL Cruz Bermúdez, J Cruz Rojo, A Dagliati, M Daniar, C Daniel, A Davoudi, B Devkota, J Dubiel, L Esteve, S Fan, RW Follett, PSA Gaiolla, T Ganslandt, N García Barrio, LX Garmire, N Gehlenborg, A Geva, T Gradinger, A Gramfort, R Griffier, N Griffon, O Grisel, DA Hanauer, C Haverkamp, B He, DW Henderson, M Hilka, JH Holmes, P Horki, KM Huling, MR Hutch, RW Issitt, AS Jannot, V Jouhet, R Kavuluru, MS Keller, K Kirchoff, JG Klann, ID Krantz, D Kraska, AK Krishnamurthy, S L’Yi, J Leblanc, ARR Leite, G Lemaitre, L Lenert, D Leprovost, M Liu, S Lozano-Zahonero, KE Lynch, S Mahmood, S Maidlow, AC Makoudjou Tchendjou, A Malovini, KD Mandl, C Mao, A Maram, P Martel, AJ Masino, ME Matheny, T Maulhardt, M Mazzitelli, MT McDuffie, A Mensch, F Ashraf, M Milano, MF Minicucci, B Moal, C Moraleda, JS Morris, KL Moshal, S Mousavi, DA Murad, SN Murphy, TP Naughton, A Neuraz, JB Norman, J Obeid, MP Okoshi, KL Olson, N Orlova, BD Ostasiewski, NP Palmer, N Paris, M Pedrera Jimenez, ER Pfaff, D Pillion, HU Prokosch, RA Prudente, V Quirós González, RB Ramoni, M Raskin, S Rieg, G Roig Domínguez, P Rojo, C Sáez, E Salamanca, A Sandrin, JCC Santos, M Savino, J Schuettler, L Scudeller, NJ Sebire, PS Balazote, P Serre, A Serret-Larmande, Z Shakeri, D Silvio, P Sliz, C Sonday, A Spiridou, BWQ Tan, BWL Tan, SE Tanni, DM Taylor, AI Terriza-Torres, V Tibollo, P Tippmann, C Torti, EM Trecarichi, YJ Tseng, AK Vallejos, G Varoquaux, M Vella, JJ Vie, M Vitacca, KB Wagholikar, LR Waitman, D Wassermann, GM Weber, Y William, N Yehya, A Zambelli, HG Zhang, D Zoeller, C Zucco, S Visweswaran, DL Mowery, Z Xia. “Multinational characterization of neurological phenotypes in patients hospitalized with COVID-19”, Scientific Reports 11(1):20238 (2021). doi:10.1038/s41598-021-99481-9