Neurological manifestations of COVID-19 worsen prognosis

Results of a large, prospective study of hospitalised adults with SARS-CoV-2 infection showed that encephalopathy at admission was common and associated with worse outcomes. Serious neurological manifestations including stroke, seizure, and meningitis/encephalitis, though less common, were all associated with increased ICU support utilisation, more severe disease, and worse outcomes.

Prospective, multicentre data on neurological manifestations of COVID-19 are still scarce. A prospective, observational study of hospitalised adults with laboratory-confirmed SARS-CoV-2 infection described the prevalence, associated risk factors, and outcomes of serious neurological manifestations, notably encephalopathy, stroke, seizure, and meningo-encephalitis. The database consisted of 16,225 hospitalised adults in 179 hospitals in 24 countries, enrolled in the SCCM Discovery VIRUS COVID-19 registry (NCT04323787), with available discharge data. Dr Anna Cervantes-Arslanian (Boston University School of Medicine, MA, USA) presented the results [1]. Results were also published in Critical Care Explorations in April 2022 [2].

Of the study population, 2,092 (12.9%) developed serious neurological manifestations: 1,656 (10.2%) presented with encephalopathy at admission, 331 (2.0%) had a stroke, 243 (1.5%) had a seizure, and 73 (0.5%) had meningitis/encephalitis at admission or during their stay in the hospital. Risk factors for serious neurological manifestations were older age and higher prevalence of chronic medical conditions, including vascular diseases. Patients with severe neurological manifestation were less likely to have systemic viral symptoms (fever, dyspnoea, and cough) and were less likely to have milder neurological symptoms such as headache, anosmia, and dysgeusia.

All of the serious neurological manifestations were associated with more severe disease, increased ICU support utilisation, and worse outcomes: In patients with serious neurological manifestations the OR for more serious disease, as defined by the WHO ordinal disease severity scale, was 1.82 (P<0.001). The OR for admittance to the ICU was 1.45 (P<0.001). ICU interventions were also more frequent: OR 1.78 for extracorporeal membrane oxygenation (P=0.009) and OR 1.99 for replacement therapy (P<0.001). Hospital and 28-day mortality were higher (OR 1.51 and 1.58; P<0.001), while the number of ICU-free, hospital-free, and ventilator-free days was lower (estimated difference in days -0.84, -1.34, and -0.84; P<0.001).

1. Cervantes-Arslanian AM, et al. Neurologic Manifestations of Patients Hospitalized with COVID-19 in the SCCM VIRUS Registry. S18.001, AAN 2022, 02–07 April, Seattle, USA.


2. Cervantes-Arslanian AM, et al. Crit Care Explor. 2022;4(4):e0686.

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Posted on 2 June, 202213 June, 2022