Risk Factors Increase Risk of Neurological Complications in Patients Hospitalised With COVID-19

July 28, 2021
Coronavirus disease 2019 (COVID-19) amplifies the risk of stroke in hospitalised patients, especially in younger people, with risk factors such as diabetes and high blood pressure contributing to this increased risk, according to a study published in Brain Communications. During the first wave of the pandemic in 2020, Amy L. Ross-Russell, MD, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, and colleagues set up a rapid response, on-line anonymised data platform hosted by the Clinical Informatics Research Unit at the University of Southampton which enabled doctors throughout the United Kingdom to report COVID-19-related neurological and psychiatric problems. Of the 267 cases, cerebrovascular events were most frequently reported (49%), followed by other central disorders (36%) including delirium (11%), central inflammatory (9%), psychiatric (9%), and other encephalopathies (7%), including severe encephalopathy (n = 13) not meeting delirium criteria; and peripheral nerve-disorders (15%). Those with the severe encephalopathy, in comparison to delirium, were younger, had higher rates of admission to intensive care and a longer duration of ventilation. Compared with normative data during the equivalent time-period prior to the pandemic, cases of stroke in association with COVID-19 were younger, with 27% of strokes occurring in patients aged younger than 60 years, and many having modifiable risk factors such as diabetes and high blood pressure. Relative to those aged older than 60 years, younger patients who had a stroke presented with delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion, and systemic thrombotic events. Clinical outcomes varied between disease groups, with cerebrovascular disease conferring the worst prognosis, but this effect was less marked than the pre-morbid factors of older age and a higher pre-COVID-19 frailty score, and a high admission white cell count, which was independently associated with a poor outcome. “It was striking not only how many different neurological and psychiatric events we observed in this study, but also that some of these conditions occurred together within the same patients,” said Dr. Ross-Russell. “This suggests that COVID-19 can affect multiple parts of the nervous system in the same patient. Patients with strokes also had blood vessel blockages or thrombosis elsewhere in the body so this is important for understanding why some strokes occur during COVID-19.” “We found that the health status of patients prior to COVID predicted how much they recovered from neurological complications, which is important from a public health perspective,” added Ian Galea, MD, University of Southampton. “Optimising health status could be a vital way to increase our resilience to this and future pandemics.” Reference: https://academic.oup.com/braincomms/advance-article/doi/10.1093/braincom... SOURCE: University of Southampton