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Journal Articles PLoS ONE Year : 2022

Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis

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Suzannah Lant
  • Function : Author
Sofia Cividini
Jonathan Cattrall
  • Function : Author
Lynsey Goodwin
Laura Benjamin
  • Function : Author
Benedict Michael
  • Function : Author
Ayaz Khawaja
  • Function : Author
Aline de Moura Brasil Matos
Walid Alkeridy
Andrea Pilotto
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Durjoy Lahiri
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Rebecca Rawlinson
  • Function : Author
Sithembinkosi Mhlanga
  • Function : Author
Evelyn Lopez
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Brendan Sargent
  • Function : Author
Anushri Somasundaran
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Arina Tamborska
  • Function : Author
Glynn Webb
  • Function : Author
Komal Younas
  • Function : Author
Yaqub Al Sami
  • Function : Author
Heavenna Babu
  • Function : Author
Tristan Banks
  • Function : Author
Francesco Cavallieri
  • Function : Author
Matthew Cohen
  • Function : Author
Emma Davies
Shalley Dhar
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Anna Fajardo Modol
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Hamzah Farooq
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Jeffrey Harte
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Samuel Hey
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Albert Joseph
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Dileep Karthikappallil
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Daniel Kassahun
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Gareth Lipunga
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Rachel Mason
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Thomas Minton
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Gabrielle Mond
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Joseph Poxon
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Sophie Rabas
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Germander Soothill
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Marialuisa Zedde
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Konstantin Yenkoyan
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Bruce Brew
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Erika Contini
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Lucette Cysique
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Xin Zhang
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Pietro Maggi
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Vincent van Pesch
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Jérome Lechien
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Sven Saussez
Alex Heyse
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Maria Lúcia Brito Ferreira
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Cristiane Soares
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Isabel Elicer
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Laura Eugenín-von Bernhardi
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Waleng Ñancupil Reyes
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Rong Yin
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Mohammed Azab
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Foad Abd-Allah
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Ahmed Elkady
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Jean-Christophe Corvol
Cécile Delorme
Norbert Lorenz
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Daniel Hornuss
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Jonas Hosp
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Siegbert Rieg
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Dirk Wagner
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Benjamin Knier
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Paul Lingor
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Andrea Sylvia Winkler
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Athena Sharifi-Razavi
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Shima Moein
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Seyedahmad Seyedalinaghi
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Mauro Morassi
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Alessandro Padovani
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Marcello Giunta
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Ilenia Libri
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Simone Beretta
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Sabrina Ravaglia
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Matteo Foschi
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Paolo Calabresi
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Guido Primiano
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Serenella Servidei
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Nicola Biagio Mercuri
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Claudio Liguori
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Mariangela Pierantozzi
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Loredana Sarmati
Federica Boso
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Silvia Garazzino
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Sara Mariotto
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Kimani Patrick
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Oana Costache
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Alexander Pincherle
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Frederikus Klok
Roger Meza
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Verónica Cabreira
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Sofia Valdoleiros
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Vanessa Oliveira
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Igor Kaimovsky
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Alla Guekht
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Jasmine Koh
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Eva Fernández Díaz
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José María Barrios-López
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Cristina Guijarro-Castro
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Álvaro Beltrán-Corbellini
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Javier Martínez-Poles
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Alba María Diezma-Martín
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Maria Isabel Morales-Casado
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Sergio García García
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Gautier Breville
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Matteo Coen
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Marjolaine Uginet
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Raphaël Bernard-Valnet
Renaud Du Pasquier
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Yildiz Kaya
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Loay Abdelnour
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Claire Rice
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Hamish Morrison
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Sylviane Defres
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Saif Huda
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Noelle Enright
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Jane Hassell
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Lucio d'Anna
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Matthew Benger
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Laszlo Sztriha
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Eamon Raith
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Krishna Chinthapalli
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Ross Nortley
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Ross Paterson
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Arvind Chandratheva
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David Werring
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Samir Dervisevic
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Kirsty Harkness
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Ashwin Pinto
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Dinesh Jillella
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Scott Beach
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Kulothungan Gunasekaran
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Ivan Rocha Ferreira da Silva
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Krishna Nalleballe
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Jonathan Santoro
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Tyler Scullen
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Lora Kahn
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Carla Kim
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Kiran Thakur
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Rajan Jain
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Thirugnanam Umapathi
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Timothy Nicholson
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James Sejvar
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Eva Maria Hodel
Catrin Tudur Smith
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Tom Solomon
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Abstract

Background: 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. Methods: 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. Results: 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. Interpretation: 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.

Dates and versions

hal-03690698 , version 1 (08-06-2022)

Licence

Attribution - CC BY 4.0

Identifiers

Cite

Bhagteshwar Singh, Suzannah Lant, Sofia Cividini, Jonathan Cattrall, Lynsey Goodwin, et al.. Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis. PLoS ONE, 2022, 17 (6), pp.e0263595. ⟨10.1371/journal.pone.0263595⟩. ⟨hal-03690698⟩
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