Abstract and Introduction
Abstract
Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models.
Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001).
Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age.
In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age.
Introduction
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic in 2020, the medical community has had concerns about its neurological effects. COVID-19 is associated with a range of neurological manifestations such as altered consciousness, fatigue, seizures and altered sense of smell and taste. In addition, in-hospital neurological complications such as stroke, CNS infection and seizures have been reported in both adults and children with acute COVID-19.[1–3] Evidence regarding the neurological effects of COVID-19 has evolved over time but was initially based on the early report from Wuhan, China, that 36% of patients had neurological manifestations.[4] That report was followed by multicentre cohort studies,[5–8] comprehensive reviews and meta-analyses[2,3,9,10] and emerging evidence on CNS involvement of the virus.[11–13] Despite many reports during the pandemic, limited data exist on the prevalence of different neurological manifestations and complications in adults and children with COVID-19. Therefore, a robust, large-scale epidemiological study is needed on the prevalence, risk factors and outcomes in adults and children with COVID-19. We sought to characterize neurological manifestations of COVID-19 among hospitalized adults and children in a large, international registry, with the aim of (i) determining the prevalence of neurological diagnoses, risk factors and associations with outcomes; (ii) differences between adults and children; and (iii) trends over time.
Here, we present data on the prevalence of neurological manifestations and complications from an international cohort of hospitalized COVID-19 patients registered in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 database. This repository collects data from 1507 sites across 61 countries. The primary aim was to describe different neurological manifestations present on admission and in-hospital neurological complications in children and adults. The secondary aims included risk factors, outcomes and trends over time for in-hospital neurological complications.
Brain. 2023;146(4):1648-1661. © 2023 Oxford University Press
