Neuropsychiatric complications of coronavirus disease 2019: Mount Sinai Health System cohort study

期刊论文
发表日期：

2024年4月24日

查看全文

Kapil Gururangan,
Veronica J. Peschansky,
Grace Van Hyfte,
Parul Agarwal,
Leah J. Blank,
Brian Mathew,
Jonathan Goldstein,
Churl-Su Kwon,
Louise McCarthy,
Ariella Cohen,
Andy Ho Wing Chan,
Pojen Deng,
Mandip Dhamoon,
Eveline Gutzwiller,
Qing Hao,
Celestine He,
Britany Klenofsky,
Hernan Nicolas Lemus,
Lara Marcuse,
Allison Navis,
Wilson D. Heredia Nunez,
Mallory N. Luckey,
Emily M. Schorr,
Anuradha Singh,
Gabriela B. Tantillo,
Claire Ufongene,
James J. Young,
Priti Balchandani,
Joanne R. Festa,
Georges Naasan,
Alexander W. Charney,
Girish N. Nadkarni,
Nathalie Jetté

摘要

Objective

To describe the frequency of neuropsychiatric complications among hospitalized patients with coronavirus disease 2019 (COVID-19) and their association with pre-existing comorbidities and clinical outcomes.

Methods

We retrospectively identified all patients hospitalized with COVID-19 within a large multicenter New York City health system between March 15, 2020 and May 17, 2021 and randomly selected a representative cohort for detailed chart review. Clinical data, including the occurrence of neuropsychiatric complications (categorized as either altered mental status [AMS] or other neuropsychiatric complications) and in-hospital mortality, were extracted using an electronic medical record database and individual chart review. Associations between neuropsychiatric complications, comorbidities, laboratory findings, and in-hospital mortality were assessed using multivariate logistic regression.

Results

Our study cohort consisted of 974 patients, the majority were admitted during the first wave of the pandemic. Patients were treated with anticoagulation (88.4%), glucocorticoids (24.8%), and remdesivir (10.5%); 18.6% experienced severe COVID-19 pneumonia (evidenced by ventilator requirement). Neuropsychiatric complications occurred in 58.8% of patients; 39.8% experienced AMS; and 19.0% experienced at least one other complication (seizures in 1.4%, ischemic stroke in 1.6%, hemorrhagic stroke in 1.0%) or symptom (headache in 11.4%, anxiety in 6.8%, ataxia in 6.3%). Higher odds of mortality, which occurred in 22.0%, were associated with AMS, ventilator support, increasing age, and higher serum inflammatory marker levels. Anticoagulant therapy was associated with lower odds of mortality and AMS.

Conclusion

Neuropsychiatric complications of COVID-19, especially AMS, were common, varied, and associated with in-hospital mortality in a diverse multicenter cohort at an epicenter of the COVID-19 pandemic.