Older adults with epilepsy and COVID-19 : Outcomes in a multi-hospital health system
Copyright © 2023 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved..
BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy.
METHODS: This retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS).
RESULTS: We identified 5384 older adults admitted with COVID-19 of whom 173 (3.21 %) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p = 0.007). Older adults with epilepsy were more likely to be ventilated (35.84 % vs. 16.18 %, p < 0.001), less likely to be discharged home (21.39 % vs. 43.12 %, p < 0.001), had longer median LOS (13 days vs. 8 days, p < 0.001), and had higher in-hospital death (35.84 % vs. 28.29 %, p = 0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95 % CI 1.12-2.14, p = 0.032), non-routine discharge disposition (aOR, 3.34; 95 % CI 2.21-5.03, p < 0.001), and longer LOS (46.46 % 95 % CI 34 %-59 %, p < 0.001).
CONCLUSIONS: In models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:114 |
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| Enthalten in: |
Seizure - 114(2024) vom: 05. Jan., Seite 33-39 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ufongene, Claire [VerfasserIn] |
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| Links: |
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| Themen: |
Comorbidity |
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| Anmerkungen: |
Date Completed 23.01.2024 Date Revised 07.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.seizure.2023.11.018 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM365308005 |
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| 500 | |a Date Revised 07.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy | ||
| 520 | |a METHODS: This retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS) | ||
| 520 | |a RESULTS: We identified 5384 older adults admitted with COVID-19 of whom 173 (3.21 %) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p = 0.007). Older adults with epilepsy were more likely to be ventilated (35.84 % vs. 16.18 %, p < 0.001), less likely to be discharged home (21.39 % vs. 43.12 %, p < 0.001), had longer median LOS (13 days vs. 8 days, p < 0.001), and had higher in-hospital death (35.84 % vs. 28.29 %, p = 0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95 % CI 1.12-2.14, p = 0.032), non-routine discharge disposition (aOR, 3.34; 95 % CI 2.21-5.03, p < 0.001), and longer LOS (46.46 % 95 % CI 34 %-59 %, p < 0.001) | ||
| 520 | |a CONCLUSIONS: In models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Comorbidity | |
| 650 | 4 | |a Hospitalization | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a Seizure | |
| 700 | 1 | |a Van Hyfte, Grace |e verfasserin |4 aut | |
| 700 | 1 | |a Agarwal, Parul |e verfasserin |4 aut | |
| 700 | 1 | |a Goldstein, Jonathan |e verfasserin |4 aut | |
| 700 | 1 | |a Mathew, Brian |e verfasserin |4 aut | |
| 700 | 1 | |a Navis, Allison |e verfasserin |4 aut | |
| 700 | 1 | |a McCarthy, Louise |e verfasserin |4 aut | |
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| 700 | 1 | |a Balchandani, Priti |e verfasserin |4 aut | |
| 700 | 1 | |a Marcuse, Lara |e verfasserin |4 aut | |
| 700 | 1 | |a Naasan, Georges |e verfasserin |4 aut | |
| 700 | 1 | |a Singh, Anuradha |e verfasserin |4 aut | |
| 700 | 1 | |a Young, James |e verfasserin |4 aut | |
| 700 | 1 | |a Charney, Alexander |e verfasserin |4 aut | |
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| 700 | 1 | |a Jette, Nathalie |e verfasserin |4 aut | |
| 700 | 1 | |a Blank, Leah J |e verfasserin |4 aut | |
| 700 | 0 | |a Sinai NeuroCOVID-19 Study Group |e verfasserin |4 aut | |
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