A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications

https://doi.org/10.1016/j.jns.2021.117486Get rights and content

Highlights

  • Abnormalities in functional and cognitive outcomes occurred in >90% of patients 6-months after hospitalization for COVID-19.

  • Impaired cognition occurred in 50% of COVID-19 patients and 47% were unable to return to work at 6-months.

  • Patients with neurological complications had significantly worse functional outcomes and were less likely to return to work.

Abstract

Background

Little is known regarding long-term outcomes of patients hospitalized with COVID-19.

Methods

We conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep.

Results

Of 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N = 196 neurological patients and N = 186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 1.98, 95%CI 1.23–3.48, P = 0.02), worse ADLs (aOR 0.38, 95%CI 0.29–0.74, P = 0.01) and were less likely to return to work than controls (41% versus 64%, P = 0.04). Cognitive and Neuro-QOL metrics were similar between groups.

Conclusions

Abnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.

Keywords

Post-acute sequelae of COVID
Post-COVID syndrome
Long-hauler
Long-COVID
COVID-19
SARS-CoV-2
Outcomes
Cognitive
Quality of life
Readmission
Neurologic
Brain
Function
Anxiety
Depression
Fatigue
Sleep

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