Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Neurological Presentations and In-Hospital Complications of COVID-19 in Adults and Children: A Large Prospective Multicentre Observational Study from the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC)
46 Pages Posted: 6 Apr 2022
More...Abstract
Background The neurological manifestations of COVID-19 have not been well characterized. Our goals were to determine the prevalence of neurological diagnoses among COVID-19 patients hospitalized in intensive care unit (ICU) and non-ICU settings and ascertain differences between adults and children.
Methods We analysed the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database, which collects data from 61 countries and 1507 sites. 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 hospitalisation using generalised linear models.
Findings Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 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%). Among adults, rates were significantly higher in the ICU cohort than in the non-ICU cohort for myalgia (19·9% vs. 16·1%, p<0·001) and anosmia (6·3% vs. 5·9%, p=0·01) but lower in the ICU cohort for altered consciousness (10·8% vs. 24%, p<0·001) and seizure (0·8% vs. 1·2%, p<0·001). In children, rates were significantly higher in the ICU cohort than in the non-ICU cohort for fatigue (30·4% vs. 18·7%, p<0·001), myalgia (12·8% vs. 6·7%, p<0·001), and altered consciousness (12% vs. 5·7%, p<0·001). In adults, the most frequent in-hospital neurological complications were stroke (1·5%), seizure (1%), and central nervous system (CNS) infection (0·2%). Each occurred more frequently in ICU than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU than in non-ICU patients (7·1 vs. 2·3, p<0·001).
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 neurological complications reported during hospitalisation were associated with increased odds of death.
Interpretation Adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Hypertension and previous neurological disease are risk factors for in-hospital neurological complications, which are associated with an increased probability of death in both adults and children.
Funding Information: ISARIC4C is funded by two major awards from UK Research and Innovation (UKRI) and The National Institute for Health Research (NIHR). S.M.C. is funded by NHLBI 1K23HL157610. N.W. was funded by an Advance Queensland Industry Research Fellowship (AQIRF076-2020-CV).
Declaration of Interests: None to declare.
Ethics Approval Statement: The study was approved by the World Health Organization Ethics Review Committee (RPC571 and RPC572). Local ethics approval was obtained for each participating country and site according to local requirements.
Keywords: COVID-19, SARS-CoV-2, adults, children, neurological presentation, neurological complication, stroke, seizure, meningitis, encephalitis.
Suggested Citation: Suggested Citation