Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19 : a UK-wide cross-sectional surveillance study
© The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain..
SARS-CoV-2 is associated with new-onset neurological and psychiatric conditions. Detailed clinical data, including factors associated with recovery, are lacking, hampering prediction modelling and targeted therapeutic interventions. In a UK-wide cross-sectional surveillance study of adult hospitalized patients during the first COVID-19 wave, with multi-professional input from general and sub-specialty neurologists, psychiatrists, stroke physicians, and intensivists, we captured detailed data on demographics, risk factors, pre-COVID-19 Rockwood frailty score, comorbidities, neurological presentation and outcome. A priori clinical case definitions were used, with cross-specialty independent adjudication for discrepant cases. Multivariable logistic regression was performed using demographic and clinical variables, to determine the factors associated with outcome. A total of 267 cases were included. Cerebrovascular events were most frequently reported (131, 49%), followed by other central disorders (95, 36%) including delirium (28, 11%), central inflammatory (25, 9%), psychiatric (25, 9%), and other encephalopathies (17, 7%), including a severe encephalopathy (n = 13) not meeting delirium criteria; and peripheral nerve disorders (41, 15%). Those with the severe encephalopathy, in comparison to delirium, were younger, had higher rates of admission to intensive care and a longer duration of ventilation. Compared to normative data during the equivalent time period prior to the pandemic, cases of stroke in association with COVID-19 were younger and had a greater number of conventional, modifiable cerebrovascular risk factors. Twenty-seven per cent of strokes occurred in patients <60 years. Relative to those >60 years old, the younger stroke patients presented with delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion (31%) and systemic thrombotic events. Clinical outcomes varied between disease groups, with cerebrovascular disease conferring the worst prognosis, but this effect was less marked than the pre-morbid factors of older age and a higher pre-COVID-19 frailty score, and a high admission white cell count, which were independently associated with a poor outcome. In summary, this study describes the spectrum of neurological and psychiatric conditions associated with COVID-19. In addition, we identify a severe COVID-19 encephalopathy atypical for delirium, and a phenotype of COVID-19 associated stroke in younger adults with a tendency for multiple infarcts and systemic thromboses. These clinical data will be useful to inform mechanistic studies and stratification of patients in clinical trials.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:3 |
|---|---|
| Enthalten in: |
Brain communications - 3(2021), 3 vom: 18., Seite fcab168 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Ross Russell, Amy L [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
COVID-19 |
|---|
| Anmerkungen: |
Date Revised 13.03.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.1093/braincomms/fcab168 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM329527878 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM329527878 | ||
| 003 | DE-627 | ||
| 005 | 20240313233126.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1093/braincomms/fcab168 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1326.xml |
| 035 | |a (DE-627)NLM329527878 | ||
| 035 | |a (NLM)34409289 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Ross Russell, Amy L |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19 |b a UK-wide cross-sectional surveillance study |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 13.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. | ||
| 520 | |a SARS-CoV-2 is associated with new-onset neurological and psychiatric conditions. Detailed clinical data, including factors associated with recovery, are lacking, hampering prediction modelling and targeted therapeutic interventions. In a UK-wide cross-sectional surveillance study of adult hospitalized patients during the first COVID-19 wave, with multi-professional input from general and sub-specialty neurologists, psychiatrists, stroke physicians, and intensivists, we captured detailed data on demographics, risk factors, pre-COVID-19 Rockwood frailty score, comorbidities, neurological presentation and outcome. A priori clinical case definitions were used, with cross-specialty independent adjudication for discrepant cases. Multivariable logistic regression was performed using demographic and clinical variables, to determine the factors associated with outcome. A total of 267 cases were included. Cerebrovascular events were most frequently reported (131, 49%), followed by other central disorders (95, 36%) including delirium (28, 11%), central inflammatory (25, 9%), psychiatric (25, 9%), and other encephalopathies (17, 7%), including a severe encephalopathy (n = 13) not meeting delirium criteria; and peripheral nerve disorders (41, 15%). Those with the severe encephalopathy, in comparison to delirium, were younger, had higher rates of admission to intensive care and a longer duration of ventilation. Compared to normative data during the equivalent time period prior to the pandemic, cases of stroke in association with COVID-19 were younger and had a greater number of conventional, modifiable cerebrovascular risk factors. Twenty-seven per cent of strokes occurred in patients <60 years. Relative to those >60 years old, the younger stroke patients presented with delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion (31%) and systemic thrombotic events. Clinical outcomes varied between disease groups, with cerebrovascular disease conferring the worst prognosis, but this effect was less marked than the pre-morbid factors of older age and a higher pre-COVID-19 frailty score, and a high admission white cell count, which were independently associated with a poor outcome. In summary, this study describes the spectrum of neurological and psychiatric conditions associated with COVID-19. In addition, we identify a severe COVID-19 encephalopathy atypical for delirium, and a phenotype of COVID-19 associated stroke in younger adults with a tendency for multiple infarcts and systemic thromboses. These clinical data will be useful to inform mechanistic studies and stratification of patients in clinical trials | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a encephalopathy | |
| 650 | 4 | |a neurology | |
| 650 | 4 | |a stroke | |
| 700 | 1 | |a Hardwick, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Jeyanantham, Athavan |e verfasserin |4 aut | |
| 700 | 1 | |a White, Laura M |e verfasserin |4 aut | |
| 700 | 1 | |a Deb, Saumitro |e verfasserin |4 aut | |
| 700 | 1 | |a Burnside, Girvan |e verfasserin |4 aut | |
| 700 | 1 | |a Joy, Harriet M |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Craig J |e verfasserin |4 aut | |
| 700 | 1 | |a Pollak, Thomas A |e verfasserin |4 aut | |
| 700 | 1 | |a Nicholson, Timothy R |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Nicholas W S |e verfasserin |4 aut | |
| 700 | 1 | |a Manji, Hadi |e verfasserin |4 aut | |
| 700 | 1 | |a Easton, Ava |e verfasserin |4 aut | |
| 700 | 1 | |a Ray, Stephen |e verfasserin |4 aut | |
| 700 | 1 | |a Zandi, Michael S |e verfasserin |4 aut | |
| 700 | 1 | |a Coles, Jonathan P |e verfasserin |4 aut | |
| 700 | 1 | |a Menon, David K |e verfasserin |4 aut | |
| 700 | 1 | |a Varatharaj, Aravinthan |e verfasserin |4 aut | |
| 700 | 1 | |a McCausland, Beth |e verfasserin |4 aut | |
| 700 | 1 | |a Ellul, Mark A |e verfasserin |4 aut | |
| 700 | 1 | |a Thomas, Naomi |e verfasserin |4 aut | |
| 700 | 1 | |a Breen, Gerome |e verfasserin |4 aut | |
| 700 | 1 | |a Keddie, Stephen |e verfasserin |4 aut | |
| 700 | 1 | |a Lunn, Michael P |e verfasserin |4 aut | |
| 700 | 1 | |a Burn, John P S |e verfasserin |4 aut | |
| 700 | 1 | |a Quattrocchi, Graziella |e verfasserin |4 aut | |
| 700 | 1 | |a Dixon, Luke |e verfasserin |4 aut | |
| 700 | 1 | |a Rice, Claire M |e verfasserin |4 aut | |
| 700 | 1 | |a Pengas, George |e verfasserin |4 aut | |
| 700 | 1 | |a Al-Shahi Salman, Rustam |e verfasserin |4 aut | |
| 700 | 1 | |a Carson, Alan |e verfasserin |4 aut | |
| 700 | 1 | |a Joyce, Eileen M |e verfasserin |4 aut | |
| 700 | 1 | |a Turner, Martin R |e verfasserin |4 aut | |
| 700 | 1 | |a Benjamin, Laura A |e verfasserin |4 aut | |
| 700 | 1 | |a Solomon, Tom |e verfasserin |4 aut | |
| 700 | 1 | |a Kneen, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Pett, Sarah |e verfasserin |4 aut | |
| 700 | 1 | |a Thomas, Rhys H |e verfasserin |4 aut | |
| 700 | 1 | |a Michael, Benedict D |e verfasserin |4 aut | |
| 700 | 1 | |a Galea, Ian |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Brain communications |d 2019 |g 3(2021), 3 vom: 18., Seite fcab168 |w (DE-627)NLM302151036 |x 2632-1297 |7 nnns |
| 773 | 1 | 8 | |g volume:3 |g year:2021 |g number:3 |g day:18 |g pages:fcab168 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1093/braincomms/fcab168 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 3 |j 2021 |e 3 |b 18 |h fcab168 | ||