Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis
<h4>Background</h4> 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 clinica...
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9162376/?tool=EBI |
| _version_ | 1828516744452374528 |
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| author | 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 Jérome Lechien Sven Saussez Alex Heyse Maria Lúcia Brito Ferreira Cristiane N. Soares Isabel Elicer Laura Eugenín-von Bernhardi Waleng Ñancupil Reyes Rong Yin Mohammed A. Azab Foad Abd-Allah Ahmed Elkady Simon Escalard Jean-Christophe Corvol Cécile Delorme Pierre Tattevin Kévin 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 Verónica Cabreira Sofia R. Valdoleiros Vanessa Oliveira Igor Kaimovsky Alla Guekht Jasmine Koh Eva Fernández Díaz José María Barrios-López Cristina Guijarro-Castro Álvaro Beltrán-Corbellini Javier Martínez-Poles Alba María Diezma-Martín Maria Isabel Morales-Casado Sergio García García Gautier Breville Matteo Coen Marjolaine Uginet Raphaël 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 The Brain Infections Global COVID-Neuro Network Study Group Catrin Tudur Smith Tom Solomon |
| author_facet | 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 Jérome Lechien Sven Saussez Alex Heyse Maria Lúcia Brito Ferreira Cristiane N. Soares Isabel Elicer Laura Eugenín-von Bernhardi Waleng Ñancupil Reyes Rong Yin Mohammed A. Azab Foad Abd-Allah Ahmed Elkady Simon Escalard Jean-Christophe Corvol Cécile Delorme Pierre Tattevin Kévin 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 Verónica Cabreira Sofia R. Valdoleiros Vanessa Oliveira Igor Kaimovsky Alla Guekht Jasmine Koh Eva Fernández Díaz José María Barrios-López Cristina Guijarro-Castro Álvaro Beltrán-Corbellini Javier Martínez-Poles Alba María Diezma-Martín Maria Isabel Morales-Casado Sergio García García Gautier Breville Matteo Coen Marjolaine Uginet Raphaël 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 The Brain Infections Global COVID-Neuro Network Study Group Catrin Tudur Smith Tom Solomon |
| author_sort | Bhagteshwar Singh |
| collection | DOAJ |
| description | <h4>Background</h4> 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. <h4>Methods</h4> 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. <h4>Results</h4> 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. <h4>Interpretation</h4> 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. |
| first_indexed | 2024-12-11T18:32:14Z |
| format | Article |
| id | doaj.art-095733b27c4d4df5a2a5be6cdb896396 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-11T18:32:14Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-095733b27c4d4df5a2a5be6cdb8963962022-12-22T00:54:53ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01176Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysisBhagteshwar SinghSuzannah LantSofia CividiniJonathan W. S. CattrallLynsey C. GoodwinLaura BenjaminBenedict D. MichaelAyaz KhawajaAline de Moura Brasil MatosWalid AlkeridyAndrea PilottoDurjoy LahiriRebecca RawlinsonSithembinkosi MhlangaEvelyn C. LopezBrendan F. SargentAnushri SomasundaranArina TamborskaGlynn WebbKomal YounasYaqub Al SamiHeavenna BabuTristan BanksFrancesco CavallieriMatthew CohenEmma DaviesShalley DharAnna Fajardo ModolHamzah FarooqJeffrey HarteSamuel HeyAlbert JosephDileep KarthikappallilDaniel KassahunGareth LipungaRachel MasonThomas MintonGabrielle MondJoseph PoxonSophie RabasGermander SoothillMarialuisa ZeddeKonstantin YenkoyanBruce BrewErika ContiniLucette CysiqueXin ZhangPietro MaggiVincent van PeschJérome LechienSven SaussezAlex HeyseMaria Lúcia Brito FerreiraCristiane N. SoaresIsabel ElicerLaura Eugenín-von BernhardiWaleng Ñancupil ReyesRong YinMohammed A. AzabFoad Abd-AllahAhmed ElkadySimon EscalardJean-Christophe CorvolCécile DelormePierre TattevinKévin BigautNorbert LorenzDaniel HornussJonas HospSiegbert RiegDirk WagnerBenjamin KnierPaul LingorAndrea Sylvia WinklerAthena Sharifi-RazaviShima T. MoeinSeyedAhmad SeyedAlinaghiSaeidreza JamaliMoghadamSiahkaliMauro MorassiAlessandro PadovaniMarcello GiuntaIlenia LibriSimone BerettaSabrina RavagliaMatteo FoschiPaolo CalabresiGuido PrimianoSerenella ServideiNicola Biagio MercuriClaudio LiguoriMariangela PierantozziLoredana SarmatiFederica BosoSilvia GarazzinoSara MariottoKimani N. PatrickOana CostacheAlexander PincherleFrederikus A. KlokRoger MezaVerónica CabreiraSofia R. ValdoleirosVanessa OliveiraIgor KaimovskyAlla GuekhtJasmine KohEva Fernández DíazJosé María Barrios-LópezCristina Guijarro-CastroÁlvaro Beltrán-CorbelliniJavier Martínez-PolesAlba María Diezma-MartínMaria Isabel Morales-CasadoSergio García GarcíaGautier BrevilleMatteo CoenMarjolaine UginetRaphaël Bernard-ValnetRenaud Du PasquierYildiz KayaLoay H. AbdelnourClaire RiceHamish MorrisonSylviane DefresSaif HudaNoelle EnrightJane HassellLucio D’AnnaMatthew BengerLaszlo SztrihaEamon RaithKrishna ChinthapalliRoss NortleyRoss PatersonArvind ChandrathevaDavid J. WerringSamir DervisevicKirsty HarknessAshwin PintoDinesh JillellaScott BeachKulothungan GunasekaranIvan Rocha Ferreira Da SilvaKrishna NalleballeJonathan SantoroTyler ScullenLora KahnCarla Y. KimKiran T. ThakurRajan JainThirugnanam UmapathiTimothy R. NicholsonJames J. SejvarEva Maria HodelThe Brain Infections Global COVID-Neuro Network Study GroupCatrin Tudur SmithTom Solomon<h4>Background</h4> 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. <h4>Methods</h4> 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. <h4>Results</h4> 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. <h4>Interpretation</h4> 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.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9162376/?tool=EBI |
| spellingShingle | 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 Jérome Lechien Sven Saussez Alex Heyse Maria Lúcia Brito Ferreira Cristiane N. Soares Isabel Elicer Laura Eugenín-von Bernhardi Waleng Ñancupil Reyes Rong Yin Mohammed A. Azab Foad Abd-Allah Ahmed Elkady Simon Escalard Jean-Christophe Corvol Cécile Delorme Pierre Tattevin Kévin 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 Verónica Cabreira Sofia R. Valdoleiros Vanessa Oliveira Igor Kaimovsky Alla Guekht Jasmine Koh Eva Fernández Díaz José María Barrios-López Cristina Guijarro-Castro Álvaro Beltrán-Corbellini Javier Martínez-Poles Alba María Diezma-Martín Maria Isabel Morales-Casado Sergio García García Gautier Breville Matteo Coen Marjolaine Uginet Raphaël 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 The Brain Infections Global COVID-Neuro Network Study Group Catrin Tudur Smith Tom Solomon Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis PLoS ONE |
| title | Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis |
| title_full | Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis |
| title_fullStr | Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis |
| title_full_unstemmed | Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis |
| title_short | Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis |
| title_sort | prognostic indicators and outcomes of hospitalised covid 19 patients with neurological disease an individual patient data meta analysis |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9162376/?tool=EBI |
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mariaisabelmoralescasado prognosticindicatorsandoutcomesofhospitalisedcovid19patientswithneurologicaldiseaseanindividualpatientdatametaanalysis AT sergiogarciagarcia prognosticindicatorsandoutcomesofhospitalisedcovid19patientswithneurologicaldiseaseanindividualpatientdatametaanalysis AT gautierbreville prognosticindicatorsandoutcomesofhospitalisedcovid19patientswithneurologicaldiseaseanindividualpatientdatametaanalysis AT matteocoen prognosticindicatorsandoutcomesofhospitalisedcovid19patientswithneurologicaldiseaseanindividualpatientdatametaanalysis AT marjolaineuginet prognosticindicatorsandoutcomesofhospitalisedcovid19patientswithneurologicaldiseaseanindividualpatientdatametaanalysis AT raphaelbernardvalnet prognosticindicatorsandoutcomesofhospitalisedcovid19patientswithneurologicaldiseaseanindividualpatientdatametaanalysis AT renauddupasquier prognosticindicatorsandoutcomesofhospitalisedcovid19patientswithneurologicaldiseaseanindividualpatientdatametaanalysis AT yildizkaya 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