Neurological phenotypes among
COVID-19 positive cases

Neurological complications can worsen outcome among hospitalized COVID-19 patients, though the prevalence of neurological phenotypes across geographically diverse populations warrants evaluation.

To examine the prevalence of neurological conditions among hospitalized COVID-19 patients in multi-national populations.

Importance and objective

35,177 COVID-19 patients
348 hospitals
6 countries
3 continents
January 2020 - early September 2020
PHASE 1.1

EHR data of a multi-national, geographically diverse population

Hospitalized patients with positive SARS-CoV-2 polymerase chain reaction (PCR) test, both with and without severe COVID-19 disease.

Exposures

Define "severity"

Severe Illness Category	Clinical Events
Diagnoses	Acute Respiratory Distress Syndrome, Ventilator-associated pneumonia
Procedures	Insertion of endotracheal tube; invasive mechanical ventilation
Laboratory results	PaCO2, PaO2
Medications	General anesthetics; benzodiazepine derivatives; muscle relaxants; other hypnotics and sedatives; adrenergic and dopaminergic agents; other cardiac stimulants; other respiratory system products; phosphodiesterase inhibitors; platelet aggregation inhibitors excluding heparin;

Meet at least one of the clinical events

Frequency of each disease category and 3-digit International Classification of Disease (ICD) code of neurological diseases by countries, sites, time before and after admission for COVID-19 related hospitalization, and COVID-19 severity.

Outcomes

Workflow

34,647 patient characteristics

Is there a difference in prevalence of ICD-10 codes between before and after admission?

\frac{\textrm{number of COVID-19 positive cases diagnosed with X}}{\textrm{total number of COVID-19 positive cases at site Y}}

(X, Y)

Do sites that report more neurological code X

report more severe cases or more never severe cases?

During COVID-19-related hospitalization, severe patients had more neurological diagnoses than those without severe disease.

1.22 times more disorders of consciousness (95% CI: 1.16-1.27)
1.24 times more other cerebrovascular diseases (95% CI: 1.05-1.45)
1.36 times more nontraumatic intracerebral / intracranial hemorrhage (95% CI: 1.10-1.67)
1.72 times more myopathy (95% CI: 1.51-1.95)

Key findings

tiny.cc/neuro4ce

to paper

Neurological phenotypes among COVID-19 positive cases