Multinational characterization of neurological phenotypes in patients hospitalized with COVID-19.
Trang T Le, Alba Gutiérrez-Sacristán, Jiyeon Son, Chuan Hong, Andrew M South, Brett K Beaulieu-Jones, Ne Hooi Will Loh, Yuan Luo, Michele Morris, Kee Yuan Ngiam, Lav P Patel, Malarkodi J Samayamuthu, Emily Schriver, Amelia L M Tan, Jason Moore, Tianxi Cai, Gilbert S Omenn, Paul Avillach, Isaac S Kohane, Consortium for Clinical Characterization of COVID-19 by EHR (4CE), Shyam Visweswaran, Danielle L Mowery, Zongqi Xia
Author Information
Trang T Le: Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Alba Gutiérrez-Sacristán: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Jiyeon Son: Department of Neurology, University of Pittsburgh, Biomedical Science Tower 3, Suite 7014, 3501 5th Avenue, Pittsburgh, PA, 15260, USA.
Chuan Hong: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Andrew M South: Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC, USA.
Brett K Beaulieu-Jones: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Ne Hooi Will Loh: Department of Critical Care, National University Health Systems, Singapore, Singapore.
Yuan Luo: Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.
Michele Morris: Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA.
Kee Yuan Ngiam: Department of Surgery, National University Health Systems, Singapore, Singapore.
Lav P Patel: Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Malarkodi J Samayamuthu: Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA.
Emily Schriver: Data Analytics Center, University of Pennsylvania Health System, Philadelphia, PA, USA.
Amelia L M Tan: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Jason Moore: Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Tianxi Cai: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Gilbert S Omenn: Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA.
Paul Avillach: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Isaac S Kohane: Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Shyam Visweswaran: Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA.
Danielle L Mowery: Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Zongqi Xia: Department of Neurology, University of Pittsburgh, Biomedical Science Tower 3, Suite 7014, 3501 5th Avenue, Pittsburgh, PA, 15260, USA. zxia1@post.harvard.edu.
Neurological complications worsen outcomes in COVID-19. To define the prevalence of neurological conditions among hospitalized patients with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test in geographically diverse multinational populations during early pandemic, we used electronic health records (EHR) from 338 participating hospitals across 6 countries and 3 continents (January-September 2020) for a cross-sectional analysis. We assessed the frequency of International Classification of Disease code of neurological conditions by countries, healthcare systems, time before and after admission for COVID-19 and COVID-19 severity. Among 35,177 hospitalized patients with SARS-CoV-2 infection, there was an increase in the proportion with disorders of consciousness (5.8%, 95% confidence interval [CI] 3.7-7.8%, p < 0.001) and unspecified disorders of the brain (8.1%, 5.7-10.5%, p < 0.001) when compared to the pre-admission proportion. During hospitalization, the relative risk of disorders of consciousness (22%, 19-25%), cerebrovascular diseases (24%, 13-35%), nontraumatic intracranial hemorrhage (34%, 20-50%), encephalitis and/or myelitis (37%, 17-60%) and myopathy (72%, 67-77%) were higher for patients with severe COVID-19 when compared to those who never experienced severe COVID-19. Leveraging a multinational network to capture standardized EHR data, we highlighted the increased prevalence of central and peripheral neurological phenotypes in patients hospitalized with COVID-19, particularly among those with severe disease.
References
Behav Brain Res. 2001 Nov 1;125(1-2):279-84
[PMID: 11682119]
