Clinical Findings of Neuro-COVID Patients Hospitalized at the COVID-19 Isolation Hospital
This hospital treated 1073 COVID-19 patients during the study period. A total of 352 patients were included in the study analyses as these patients were diagnosed with COVID-19 who presented with clinical nervous system involvement (Neuro-COVID patients). As presented in Table 1, out of the total Neuro-COVID patients, 183 (52%) were females and 169 (48%) were males. The mean age was 36.64 ± 18.97 (range 17–95) years and thus, more patients were found in the younger age group 20–39 years (193 [54.8%]), followed by 60 (17%) patients aged 40–59 years; 55 (15.6%) patients aged 60 to 79 years; 37 (10.5%) patients aged ˂20 years and only 7 (2%) patients were aged 80 years or above. Almost half of the total Neuro-COVID patients (161 [45.7%]) had underlying conditions including non- neurological (155 [44%]) and neurological comorbidities (24 [6.8%]). Most common nervous system involvement was NMS (240 [68.2%]), followed by CNS (164 [46.6%]) and PNS (125 [35.5%]), whereas, PSY presentations (4 [1.1%]) were the least common. Particularly, myalgia (215 [61.1%]); anosmia (118 [33.5%]); headache (100 [28.4%]); ageusia (80 [22.7%]); altered level of consciousness (LOC) (56 [15.9%]); arthralgia (43 [12.2%]) and dizziness (12 [3.4%]) were predominant in Neuro-COVID patients. Seizure, hypogeusia, paraparesis or paraplegia were each reported in 4 (1.1%) patients, whilst, other presentations reported in less than one percent of patients, included hemiparesis, aphasia, dysarthria, UMN facial palsy, unequal pupils, signs of meningitis, paraesthesia, faecal incontinence, urinary retention, hyposmia, blurred vision, visual hallucination, agitation, depressed mood, insomnia, suicidal thoughts and psychosis. Majority of Neuro-COVID patients were determined as moderate (271 [77%]) and there were 29 (8.2%) severe cases and 52 (14.8%) critical cases. Finally, the clinical outcome was 304 (86.4%) discharges and 48 (13.6%) deaths. (Table 1)
Table 1
Distribution of clinical findings amongst Neuro-COVID patients with different ages
Variable | Age Group (years) |
Total (n = 352) No. (%) | < 20 (n = 37) No. (%) | 20–39 (n = 193) No. (%) | 40–59 (n = 60) No. (%) | 60–79 (n = 55) No. (%) | ≥ 80 (n = 7) No. (%) | P -value |
Gender | | | | | | | |
Female | 183 (52.0) | 18 (48.6) | 107 (55.4) | 28 (46.7) | 26 (47.3) | 4 (57.1) | 0.675 |
Male | 169 (48.0) | 19 (51.4) | 86 (44.6) | 32 (53.3) | 29 (52.7) | 3 (42.9) | |
Comorbidities** | 161 (45.7) | 8 (21.6) | 56 (29.0) | 40 (66.7) | 51 (92.7) | 6 (85.7) | < 0.0011 |
Neurological | 24 (6.8) | 1 (2.7) | 6 (3.1) | 4 (6.7) | 12 (21.8) | 1 (14.3) | 0.0011 |
Stroke | 13 (3.7) | 0 | 1 (0.5) | 1 (1.7) | 10 (18.2) | 1 (14.3) | < 0.0011 |
Brain/ spinal cord tumour | 5 (1.4) | 0 | 2 (1.0) | 2 (3.6) | 0 | 0 | 0.510 |
Epilepsy | 1 (0.3) | 0 | 0 | 0 | 1 (1.8) | 0 | 0.279 |
Alzheimer | 1 (0.3) | 0 | 0 | 0 | 1 (1.8) | 0 | 0.279 |
Hemiplegia | 1 (0.3) | 0 | 1 (0.5) | 0 | 0 | 0 | 1.000 |
Cerebral palsy | 1 (0.3) | 0 | 0 | 1 (1.7) | 0 | 0 | 0.450 |
Migraine | 1 (0.3) | 0 | 1 (0.5) | 0 | 0 | 0 | 1.000 |
CVST | 1 (0.3) | 0 | 1 (0.5) | 0 | 0 | 0 | 1.000 |
Myopathy | 2 (0.6) | 1 (2.7) | 0 | 1 (1.7) | 0 | 0 | 0.171 |
Psychiatric disorder | 3 (0.9) | 0 | 1 (0.5) | 0 | 2 (3.6) | 0 | 0.176 |
Non- Neurological | 155 (44.0) | 7 (18.9) | 54 (28.0) | 40 (66.7) | 48 (87.3) | 6 (85.7) | < 0.0011 |
Hypertension | 65 (18.5) | 0 | 7 (3.6) | 21 (35.0) | 33 (60.0) | 4 (57.1) | < 0.0011 |
Diabetes | 51 (14.5) | 1 (2.7) | 4 (2.1) | 15 (25.0) | 28 (50.9) | 3 (42.9) | < 0.0011 |
Asthma | 25 (7.1) | 5 (13.5) | 12 (6.2) | 6 (10.0) | 2 (3.6) | 0 | 0.286 |
Chronic sinusitis | 12 (3.4) | 0 | 12 (6.2) | 0 | 0 | 0 | 0.0451 |
Renal disease | 24 (6.8) | 0 | 0 | 9 (15.0) | 14 (25.5) | 1 (14.3) | < 0.0011 |
Cardiovascular disease | 21 (6.0) | 0 | 3 (1.6) | 3 (5.0) | 13 (23.6) | 2 (28.6) | < 0.0011 |
Malignancy | 15 (4.3) | 0 | 6 (3.1) | 5 (8.3) | 4 (7.3) | 0 | 0.161 |
Benign tumour | 2 (0.6) | 0 | 1 (0.5) | 0 | 1 (1.8) | 0 | 0.519 |
Liver disease | 11 (3.1) | 0 | 2 (1.0) | 3 (5.0) | 4 (7.3) | 2 (28.6) | 0.0011 |
Blood disorder | 9 (2.6) | 0 | 3 (1.6) | 6 (10.0) | 0 | 0 | 0.0151 |
GIT disease | 9 (2.6) | 0 | 5 (2.6) | 3 (5.0) | 0 | 1 (14.3) | 0.081 |
Rheumatic disease | 9 (2.6) | 1 (2.7) | 2 (1.0) | 4 (6.7) | 2 (3.6) | 0 | 0.177 |
Thyroid disease | 3 (0.9) | 0 | 1 (0.5) | 2 (3.3) | 0 | 0 | 0.223 |
PCOS | 1 (0.3) | 0 | 1 (0.5) | 0 | 0 | 0 | 1.000 |
Smoking | 9 (2.6) | 0 | 3 (1.6) | 1 (1.7) | 2 (3.6) | 3 (42.9) | < 0.0011 |
Substance abuse | 7 (2.0) | 0 | 3 (1.6) | 1 (1.7) | 2 (3.6) | 1 (14.3) | 0.156 |
Clinical Presentations 2 | | | | | | | |
CNS | 164 (46.6) | 11 (29.7) | 77 (39.9) | 31 (51.7) | 41 (74.5) | 4 (57.1) | < 0.0011 |
Headache | 100 (28.4) | 11 (29.7) | 64 (33.2) | 17 (28.3) | 8 (14.5) | 0 | 0.038* |
Altered LOC | 56 (15.9) | 0 | 10 (5.2) | 14 (23.3) | 28 (5.09) | 4 (57.1) | < 0.0011 |
Dizziness | 12 (3.4) | 0 | 4 (2.1) | 3 (5.0) | 4 (7.3) | 1 (14.3) | 0.076 |
Seizure | 4 (1.1) | 0 | 0 | 2 (3.3) | 1 (1.8) | 1 (14.3) | 0.0141 |
Paraparesis/ Paraplegia | 4 (1.1) | 0 | 1 (0.5) | 2 (3.3) | 1 (1.8) | 0 | 0.318 |
Hemiparesis | 1 (0.3) | 0 | 0 | 0 | 1 (1.8) | 0 | 0.279 |
Aphasia | 2 (0.6) | 0 | 0 | 1 (1.7) | 1 (1.8) | 0 | 0.227 |
Dysarthria | 2 (0.6) | 0 | 0 | 2 (3.3) | 0 | 0 | 0.102 |
UMN facial palsy | 1 (0.3) | 0 | 0 | 0 | 1 (1.8) | 0 | 0.279 |
Unequal pupils | 1 (0.3) | 0 | 0 | 1 (1.7) | 0 | 0 | 0.450 |
Signs of meningitis | 1 (0.3) | 0 | 0 | 0 | 1 (1.8) | 0 | 0.279 |
Paraesthesia | 3 (0.9) | 0 | 2 (1.0) | 1 (1.7) | 0 | 0 | 1.000 |
Faecal incontinence | 2 (0.6) | 0 | 1 (0.5) | 0 | 1 (1.8) | 0 | 0.519 |
Urinary retention | 1 (0.3) | 0 | 1 (0.5) | 0 | 0 | 0 | 1.000 |
PNS | 125 (35.5) | 22 (59.5) | 86 (44.6) | 14 (23.3) | 3 (5.5) | 0 | < 0.0011 |
Anosmia | 118 (33.5) | 22 (59.5) | 81 (42.0) | 13 (21.7) | 2 (3.6) | 0 | < 0.0011 |
Hyposmia | 3 (0.9) | 0 | 2 (1.0) | 0 | 1 (1.8) | 0 | 0.847 |
Ageusia | 80 (22.7) | 17 (45.9) | 56 (29.0) | 6 (10.0) | 1 (1.8) | 0 | < 0.0011 |
Hypogeusia | 4 (1.1) | 0 | 3 (1.6) | 0 | 1 (1.8) | 0 | 0.728 |
Blurred vision | 2 (0.6) | 0 | 1 (0.5) | 1 (1.7) | 0 | 0 | 0.704 |
NMS | 240 (68.2) | 30 (81.1) | 148 (76.7) | 39 (65.0) | 20 (36.4) | 3 (42.9) | < 0.0011 |
Myalgia | 215 (61.1) | 27 (73.0) | 133 (68.9) | 34 (56.7) | 18 (32.7) | 3 (42.9) | < 0.0011 |
Arthralgia | 43 (12.2) | 6 (16.2) | 25 (13.0) | 9 (15.0) | 3 (5.5) | 0 | 0.354 |
PSY | 4 (1.1) | 0 | 1 (0.5) | 2 (3.3) | 1 (1.8) | 0 | 0.318 |
Visual Hallucination | 2 (0.6) | 0 | 0 | 1 (1.7) | 1 (1.8) | 0 | 0.227 |
Agitation | 2 (0.6) | 0 | 1 (0.5) | 0 | 1 (1.8) | 0 | 0.519 |
Depressed mood | 1 (0.3) | 0 | 0 | 0 | 1 (1.8) | 0 | 0.279 |
Insomnia | 1 (0.3) | 0 | 0 | 0 | 1 (1.8) | 0 | 0.279 |
Suicidal thoughts | 1 (0.3) | 0 | 0 | 0 | 1 (1.8) | 0 | 0.279 |
Psychosis | 1 (0.3) | 0 | 0 | 1 (1.7) | 0 | 0 | 0.450 |
Disease Severity | | | | | | | |
Moderate | 271 (77.0) | 37 (100.0) | 176 (91.2) | 41 (68.3) | 16 (29.1) | 1 (14.3) | < 0.0011 |
Severe | 29 (8.2) | 0 | 8 (4.1) | 8 (13.3) | 11 (20.0) | 2 (28.6) | < 0.0011 |
Critical | 52 (14.8) | 0 | 9 (4.7) | 11 (18.3) | 28 (50.9) | 4 (57.1) | < 0.0011 |
Clinical Outcome | | | | | | | |
Deaths | 48 (13.6) | 0 | 8 (4.1) | 11 (18.3) | 24 (43.6) | 5 (71.4) | < 0.0011 |
Discharges | 304 (86.4) | 37 (100.0) | 185 (95.9) | 49 (81.7) | 31 (56.4) | 2 (28.6) | |
Abbreviations: CVST, cerebral venous sinus thrombosis; GIT, gastrointestinal tract; PCOS, polycystic ovary syndrome; CNS, central nervous system; LOC, loss of consciousness; UMN, upper motor neuron; PNS, peripheral nervous system; NMS, neuromusculoskeletal; PSY, psychiatric |
1 P -value < 0.05 was considered statistically significant. |
2 Patients were not mutually exclusive within this variable. |
Clinical Findings According To Age
Since Neuro-COVID patients were stratified into 5 age groups, patients below 40 years were determined as young and those 60 years or above as older patients, whilst those in between were middle aged. Table 1 shows that there were no significant differences between the age groups for females and males. More older patients had a history of comorbidities compared to the middle aged and younger patients (60–79 years = 92.7%; ≥80 = 85.7%; versus 40–59 years = 66.7%; 20–39 years = 29%; <20 years = 21.6%; P < 0.001). Moreover, older Neuro-COVID patients presented with increased incidences of CNS manifestations (60–79 years = 74.5%; ≥80 years = 57.1%; versus 40–59 years = 51.7%; 20–39 years = 39.9%; <20 years = 29.7%; P < 0.001) and either severe state (≥ 80 years = 28.6%; 60–79 years = 20%; versus 40–59 years = 13.3%; 20–39 years = 4.1%; <20 years = 0%; P < 0.001), or critical state (≥ 80 years = 57.1%; 60–79 years = 50.9%; versus 40–59 years = 18.3%; 20–39 years = 4.7%; <20 years = 0%; P < 0.001). This perhaps relates to higher incidences of deaths in older patients than other age groups (≥ 80 years = 71.4%; 60–79 years = 43.6%; versus 40–59 years = 18.3%; 20–39 years = 4.1%; <20 years = 0%; P < 0.001). On the contrary, younger Neuro-COVID patients had more PNS manifestations (< 20 years = 59.5%; 20–39 years = 44.6%; versus 40–59 years = 23.3%; 60–79 years = 5.5%; ≥80 years = 0%; P < 0.001) and NMS manifestations (< 20 years = 81.1%; 20–39 years = 76.7%; versus 40–59 years = 65%; 60–79 years = 36.4%; ≥80 years = 42.9%; P < 0.001), and since the majority were moderate cases (< 20 years = 100%; 20–39 years = 91.2%; versus 40–59 years = 68.3%; 60–79 years = 29.1%; ≥80 years = 14.3%; P < 0.001), they were more commonly discharged (< 20 years = 100%; 20–39 years = 95.9%; versus 40–59 years = 81.7%; 60–79 years = 56.4%; ≥80 years = 28.6%; P < 0.001). (Table 1)
Clinical Findings According To Comorbidities
It is evident in Table 1 that, out of the total Neuro-COVID patients, the most common comorbidities were hypertension (65 [18.5%]), diabetes (51 [50.9%]), asthma (25 [7.1%]), renal disease (24 [6.8%]), cardiovascular disease (21 [6%]), stroke (18.2%), malignancy (15 [4.3%]) and liver disease (11 [3.1%]). Table 2 shows that gender was not significantly distributed amongst Neuro-COVID patients with comorbidities. Age groups 40–59 years (with = 24.8% versus without = 10.5%; P < 0.001) and 60–79 years (with = 31.7% versus without = 2.1%; P < 0.001) had significantly more patients with comorbidities than without any comorbidities. Presence of comorbidities was more frequent in patients with CNS findings (with = 58.4% versus without = 36.6%; P < 0.001), and less frequent in patients with PNS findings (with = 25.5% versus without = 44%; P < 0.001) and NMS findings (with = 57.2% versus without = 77.5%; P < 0.001). COVID-19 disease severity and outcome amongst the patients presenting with nervous system manifestations seem to be influenced by the presence comorbidities, as majority of cases with comorbidities warranted critical care attention (with = 28.0% versus without = 3.7%; P < 0.001) and died in hospital (with = 26.7% versus without = 2.8%; P < 0.001). (Table 2)
Table 2
Distribution of clinical findings amongst Neuro-COVID patients with comorbidities
Variable | Comorbidities |
With comorbidities (n = 161) No. (%) | Without comorbidities (n = 191) No. (%) | P -value |
Gender | | | |
Female | 84 (52.2) | 99 (51.8) | 0.949 |
Male | 77 (47.8) | 92 (48.2) | |
Age Group, (years) | | | |
< 20 | 8 (5.0) | 29 (15.2) | 0.0021 |
20–39 | 56 (34.8) | 137 (71.7) | < 0.0011 |
40–59 | 40 (24.8) | 20 (10.5) | < 0.0011 |
60–79 | 51 (31.7) | 4 (2.1) | < 0.0011 |
≥ 80 | 6 (3.7) | 1 (0.5) | 0.051 |
Clinical Presentation2 | | | |
CNS | 94 (58.4) | 70 (36.6) | < 0.0011 |
Headache | 42 (26.1) | 58 (30.4) | 0.375 |
Altered level LOC | 45 (28.0) | 11 (5.8) | < 0.0011 |
Dizziness | 9 (5.6) | 3 (1.6) | 0.0381 |
Seizure | 4 (2.5) | 0 | 0.0431 |
Paraparesis/ Paraplegia | 4 (2.5) | 0 | 0.0431 |
Hemiparesis | 1 (0.6) | 0 | 0.457 |
Aphasia | 2 (1.2) | 0 | 0.208 |
Dysarthria | 2 (1.2) | 0 | 0.208 |
UMN facial palsy | 1 (0.6) | 0 | 0.457 |
Unequal pupils | 0 | 1 (0.5) | 1.000 |
Signs of meningitis | 1 (0.6) | 0 | 0.457 |
Paraesthesia | 2 (1.2) | 1 (0.5) | 0.595 |
Faecal incontinence | 2 (1.2) | 0 | 0.208 |
Urinary retention | 1 (0.6) | 0 | 0.457 |
PNS | 41 (25.5) | 84 (44.0) | < 0.0011 |
Anosmia | 36 (22.4) | 82 (42.9) | < 0.0011 |
Hyposmia | 1 (0.6) | 2 (1.0) | 1.000 |
Ageusia | 22 (13.7) | 58 (30.4) | < 0.0011 |
Hypogeusia | 1 (0.6) | 3 (1.6) | 0.628 |
Blurred vision | 2 (1.2) | 0 | 0.208 |
NMS | 92 (57.2) | 148 (77.5) | < 0.0011 |
Myalgia | 84 (52.2) | 131 (68.6) | 0.0021 |
Arthralgia | 18 (11.2) | 25 (13.1) | 0.586 |
PSY | 3 (1.9) | 1 (0.5) | 0.336 |
Visual Hallucination | 2 (1.2) | 0 | 0.208 |
Agitation | 1 (0.6) | 1 (0.5) | 1.000 |
Depressed mood | 1 (0.6) | 0 | 0.457 |
Insomnia | 1 (0.6) | 0 | 0.457 |
Suicidal thoughts | 1 (0.6) | 0 | 0.457 |
Psychosis | 1 (0.6) | 0 | 0.457 |
Disease Severity | | | |
Moderate | 92 (57.1) | 179 (93.7) | < 0.0011 |
Severe | 24 (14.9) | 5 (2.6) | < 0.0011 |
Critical | 45 (28.0) | 7 (3.7) | < 0.0011 |
Clinical Outcome | | | |
Deaths | 43 (26.7) | 5 (2.8) | < 0.0011 |
Discharges | 118 (73.3) | 186 (97.4) | |
Abbreviations: CVST, cerebral venous sinus thrombosis; GIT, gastrointestinal tract; PCOS, polycystic ovary syndrome; CNS, central nervous system; LOC, loss of consciousness; UMN, upper motor neuron; PNS, peripheral nervous system; NMS, neuromusculoskeletal; PSY, psychiatric |
1 P -value < 0.05 was considered statistically significant. |
2 Patients were not mutually exclusive within this variable. |
Clinical Findings According To Disease Severity
As shown in Table 3, the distribution of Neuro-COVID females and males was not significant across the spectrum of moderate (M), severe (S) and critical (C) cases. Majority of moderate cases were found in the age group 20–39 years (M = 64.9% versus S = 27.6%; C = 17.3%; P < 0.001). Severe and critical cases were highest in the age group 60–79 years (M = 5.9% versus S = 37.9%; C = 53.8%; P < 0.001). Critical cases accounted for significantly higher reports of hypertension (44.2%), diabetes (36.5%), renal disease (26.9%), cardiovascular disease (15.4%), stroke (15.4%), liver disease (15.4%), malignancy (13.5%), substance abuse (9.6%) and brain tumours (3.8%), than other cases with comorbidities (M = 33.9%; S = 82.8% versus C = 86.5%; P < 0.001). CNS findings were more commonly exhibited in critical cases than severe and moderate (M = 38% versus S = 58.6%; C = 84.6%; P < 0.001), yet vice versa for PNS findings (M = 43.9% versus S = 17.2%; C = 1.9%; P < 0.001) and NMS findings (M = 76.8% versus S = 55.2%; C = 30.8%; P < 0.001). Altered LOC was a serious CNS presentation since the highest frequency was observed within critical patients (73.1%), however, headache was most common amongst moderate patients (32.5%) instead of critical. Anosmia (42.1%), ageusia (28.8%), myalgia (68.6%) and arthralgia (14.8%) could be considered less serious presentations mainly exhibiting in moderate cases. Interestingly, albeit presenting at low frequencies, hyposmia (1.1%) and hypgeusia (1.5%) were only found within moderate cases; dysarthria (6.9%) and blurred vision (6.9%) were only found within severe cases; and faecal incontinence was only found within critical cases. All PSY findings ((M = 0%; S = 13.8%; C = 0%; P < 0.001) were observed amongst severe cases. Seventy-eight percent of critical cases died as compared to 24% of severe cases, while 100% of moderate cases were discharged, and this distribution was statistically significant (P < 0.001). (Table 3)
Table 3
Distribution of clinical findings for the disease severity spectrum and predictors of severity amongst Neuro-COVID patients.
Variable | Disease Severity | Severe1 | Critical2 |
Moderate (n = 271) No. (%) | Severe (n = 29) No. (%) | Critical (n = 52) No. (%) | P -value | UVA3 OR (95% CI) | P -value | MVA4 OR (95% CI) | P -value | UVA3 OR (95% CI) | P -value | MVA5 OR (95% CI) | P -value |
Gender | | | | | | | | | | | | |
Female | 135 (49.8) | 13 (44.8) | 35 (67.3) | 0.050 | 0.82 (0.38–1.77) | 0.610 | | | 2.07 (1.11–3.88) | 0.027 | 2.67 (1.10–6.48) | 0.0307 |
Male6 | 136 (50.2) | 16 (55.2) | 17 (32.7) | | Ref | | | | Ref | | | |
Age Group, (years) | | | | | | | | | | | | |
< 20 | 37 (13.7) | 0 | 0 | 0.0027 | - | - | | | - | - | | |
20–39 | 176 (64.9) | 8 (27.6) | 9 (17.3) | < 0.0017 | 0.02 (0.002–0.28) | 0.0037 | 0.04 (0.003–0.54) | 0.0167 | 0.01 (0.001–0.13) | < 0.0017 | 0.04 (0.003–0.62) | 0.0217 |
40–59 | 41 (15.1) | 8 (27.6) | 11 (21.2) | 0.165 | 0.10 (0.008–1.21) | 0.070 | 0.10 (0.007–1.44) | 0.091 | 0.07 (0.007–0.66) | 0.0217 | 0.08 (0.006–1.27) | 0.074 |
60–79 | 16 (5.9) | 11 (37.9) | 28 (53.8) | < 0.0017 | 0.34 (0.03–4.27) | 0.406 | 0.22 (0.02–3.12) | 0.262 | 0.44 (0.05–4.26) | 0.476 | 0.26 (0.02–3.77) | 0.320 |
≥ 80¶ | 1 (0.4) | 2 (6.9) | 4 (7.7) | 0.0017 | Ref | | Ref | | Ref | | Ref | |
Comorbidities8 | 92 (33.9) | 24 (82.8) | 45 (86.5) | < 0.0017 | 0.11 (0.04–0.29) | < 0.0017 | | | 0.08 (0.04–0.18) | < 0.0017 | | |
Neurological | 7 (2.6) | 5 (17.2) | 12 (23.1) | < 0.0017 | 0.13 (0.04–0.43) | 0.001* | 0.27 (0.07–1.09) | 0.066 | 0.09 (0.03–0.24) | < 0.0017 | 0.30 (0.08–1.13) | 0.075 |
Stroke | 3 (1.1) | 2 (6.9) | 8 (15.4) | < 0.0017 | 0.15 (0.02–0.94) | 0.0437 | | | 0.06 (0.002–0.24) | < 0.0017 | | |
Brain/ spinal cord tumour | 1 (0.4) | 2 (6.9) | 2 (3.8) | 0.0087 | 0.05 (0.004–0.57) | 0.0167 | | | 0.09 (0.008–1.04) | 0.054 | | |
Epilepsy | 0 | 0 | 1 (1.9) | 0.228 | - | - | | | - | - | | |
Alzheimer | 0 | 0 | 1 (1.9) | 0.228 | - | - | | | - | - | | |
Hemiplegia | 0 | 0 | 1 (1.9) | 0.228 | - | - | | | - | - | | |
Cerebral palsy | 0 | 1 (3.4) | 0 | 0.082 | - | - | | | - | - | | |
Migraine | 1 (0.4) | 0 | 0 | 1.000 | - | - | | | - | - | | |
CVST | 0 | 1 (3.4) | 0 | 0.082 | - | - | | | - | - | | |
Myopathy | 1 (0.4) | 0 | 1 (1.9) | 0.406 | - | - | | | 0.19 (0.01–3.07) | 0.241 | | |
Psychiatric disorder | 1 (0.4) | 1 (3.4) | 1 (1.9) | 0.132 | 0.10 (0.006 -1.70) | 0.113 | | | 0.19 (0.01–3.07)9 | 0.241 | | |
Non- Neurological | 89 (32.8) | 21 (72.4) | 45 (86.5) | < 0.0017 | 0.17 (0.08–0.44) | < 0.0017 | 0.40 (0.15–1.09) | 0.073 | 0.08 (0.03–0.18) | < 0.0017 | 0.14 (0.05–0.41) | < 0.0017 |
Hypertension | 28 (10.3) | 14 (48.3) | 23 (44.2) | < 0.0017 | 0.12 (0.05–0.28) | < 0.0017 | | | 0.15 (0.07–0.29) | < 0.0017 | | |
Diabetes | 24 (8.9) | 8 (27.6) | 19 (36.5) | < 0.0017 | 0.26 (0.10–0.64) | 0.0037 | | | 0.17 (0.08–0.34) | < 0.0017 | | |
Asthma | 24 (8.9) | 0 | 1 (1.9) | 0.057 | - | - | | | 4.96 (0.66–37.47) | 0.121 | | |
Chronic sinusitis | 12 (4.4) | 0 | 0 | 0.164 | - | - | | | - | - | | |
Renal disease | 6 (2.2) | 4 (13.8) | 14 (26.9) | < 0.0017 | 0.14 (0.04–0.54) | 0.0047 | | | 0.06 (0.02–0.17) | < 0.0017 | | |
Cardiovascular disease | 9 (3.3) | 4 (13.8) | 8 (15.4) | 0.0027 | 0.22 (0.06–0.75) | 0.0167 | | | 0.19 (0.07–0.52) | 0.0017 | | |
Malignancy | 3 (1.1) | 5 (17.2) | 7 (13.5) | < 0.0017 | 0.05 (0.01–0.24) | < 0.0017 | | | 0.07 (0.02–0.29) | < 0.0017 | | |
Benign tumour | 1 (0.4) | 1 (3.4) | 0 | 0.182 | 0.10 (0.006–1.70) | 0.113 | | | - | - | | |
Liver disease | 2 (0.7) | 1 (3.4) | 8 (15.4) | < 0.0017 | 0.21 (0.02–2.37) | 0.206 | | | 0.04 (0.008–0.20) | < 0.0017 | | |
Blood disorder | 6 (2.2) | 1 (3.4) | 2 (3.8) | 0.856 | 0.63 (0.07–5.46) | 0.678 | | | 0.57 (0.11–2.89) | 0.493 | | |
GIT disease | 7 (2.6) | 1 (3.4) | 1 (1.9) | 1.000 | 0.74 (0.09–6.26) | 0.784 | | | 1.35 (0.16–11.23) | 0.780 | | |
Rheumatic disease | 5 (1.8) | 0 | 4 (7.7) | 0.060 | - | - | | | 0.23 (0.06–0.87) | 0.0317 | | |
Thyroid disease | 3 (1.1) | 0 | 0 | 1.000 | - | - | | | - | - | | |
PCOS | 1 (0.4) | 0 | 0 | 1.000 | - | - | | | - | - | | |
Smoking | 4 (1.5) | 2 (6.9) | 3 (5.8) | 0.070 | 0.02 (0.04–1.16) | 0.072 | | | 0.25 (0.05–1.13) | 0.071 | | |
Substance abuse | 0 | 2 (6.9) | 5 (9.6) | < 0.0017 | - | - | | | - | - | | |
Clinical Presentations8 | | | | | | | | | | | | |
CNS | 103 (38.0) | 17 (58.6) | 44 (84.6) | < 0.0017 | 0.043 (0.20–0.94) | 0.0357 | 0.87 (0.31–2.41) | 0.783 | 0.11 (0.05–0.25) | < 0.0017 | 0.47 (0.15–1.48) | 0.197 |
Headache | 88 (32.5) | 6 (20.7) | 6 (11.5) | 0.0067 | 1.84 (0.73–4.69) | 0.199 | | | 3.69 (1.52–8.96) | 0.0047 | | |
Altered LOC | 6 (2.2) | 12 (41.4) | 38 (73.1) | < 0.0017 | 0.03 (0.01–0.10) | < 0.0017 | | | 0.008 (0.003–0.02) | < 0.0017 | | |
Dizziness | 9 (3.3) | 2 (6.9) | 1 (1.9) | 0.533 | 0.46 (0.01–2.26) | 0.341 | | | 1.75 (0.22–14.13) | 0.599 | | |
Seizure | 1 (0.4) | 0 | 3 (5.8) | 0.0137 | - | - | | | 0.06 (0.006–0.59) | 0.0167 | | |
Paraparesis/ Paraplegia | 1 (0.4) | 2 (6.9) | 1 (1.9) | 0.0227 | 0.05 (0.004–0.57) | 0.0167 | | | 0.19 (0.01–3.07) | 0.241 | | |
Hemiparesis | 0 | 0 | 1 (1.9) | 0.228 | - | - | | | - | - | | |
Aphasia | 0 | 1 (3.4) | 1 (1.9) | 0.0497 | - | - | | | - | - | | |
Dysarthria | 0 | 2 (6.9) | 0 | 0.0067 | - | - | | | - | - | | |
UMN facial palsy | 0 | 0 | 1 (1.9) | 0.228 | - | - | | | - | - | | |
Unequal pupils | 0 | 0 | 1 (1.9) | 0.228 | - | - | | | - | - | | |
Signs of meningitis | 0 | 1 (3.4) | 0 | 0.082 | - | - | | | - | - | | |
Paraesthesia | 2 (0.7) | 0 | 1 (1.9) | 0.546 | - | - | | | 0.38 (0.03–4.26) | 0.432 | | |
Faecal incontinence | 0 | 0 | 2 (3.8) | 0.0277 | - | - | | | - | - | | |
Urinary retention | 0 | 0 | 1 (1.9) | 0.228 | - | - | | | - | - | | |
PNS | 119 (43.9) | 5 (17.2) | 1 (1.9) | < 0.0017 | 3.76 (1.39–10.14) | 0.0097 | 2.19 (0.67–7.15) | 0.194 | 39.93 (5.44–293.14) | < 0.0017 | 19.54 (2.30–166.09) | 0.0067 |
Anosmia | 114 (42.1) | 3 (10.3) | 1 (1.9) | < 0.0017 | 6.29 (1.86–21.30) | 0.0037 | | | 37.03 (5.04–271.92) | < 0.0017 | | |
Hyposmia | 3 (1.1) | 0 | 0 | 1.000 | - | - | | | - | - | | |
Ageusia | 78 (28.8) | 2 (6.9) | 0 | < 0.0017 | 5.46 (1.27–23.50) | 0.0237 | | | - | - | | |
Hypogeusia | 4 (1.5) | 0 | 0 | 0.727 | - | - | | | - | - | | |
Blurred vision | 0 | 2 (6.9) | 0 | 0.0067 | - | - | | | - | - | | |
NMS | 208 (76.8) | 16 (55.2) | 16 (30.8) | < 0.0017 | 2.68 (1.22–5.88) | 0.0147 | 1.90 (0.65–5.58) | 0.243 | 7.43 (3.87–14.27) | < 0.0017 | 4.35 (1.47–12.87) | 0.0087 |
Myalgia | 186 (68.6) | 14 (48.3) | 15 (28.8) | < 0.0017 | 2.345 (1.08–5.08) | 0.0317 | | | 5.40 (2.81–10.37) | < 0.0017 | | |
Arthralgia | 40 (14.8) | 1 (3.4) | 2 (3.8) | 0.0297 | 4.85 (0.64–36.65) | 0.126 | | | 4.33 (1.01–18.50) | 0.0487 | | |
PSY | 0 | 4 (13.8) | 0 | < 0.0017 | - | - | | | - | - | | |
Visual Hallucination | 0 | 2 (6.9) | 0 | 0.0067 | - | - | | | - | - | | |
Agitation | 0 | 2 (6.9) | 0 | 0.0067 | - | - | | | - | - | | |
Depressed mood | 0 | 1 (3.4) | 0 | 0.082 | - | - | | | - | - | | |
Insomnia | 0 | 1 (3.4) | 0 | 0.082 | - | - | | | - | - | | |
Suicidal thoughts | 0 | 1 (3.4) | 0 | 0.082 | - | - | | | - | - | | |
Psychosis | 0 | 1 (3.4) | 0 | 0.082 | - | - | | | - | - | | |
Clinical Outcome | | | | | | | | | | | | |
Deaths | 0 | 7 (24.1) | 41 (78.8) | < 0.0017 | | | | | | | | |
Discharges | 271 (100.0) | 22 (75.9) | 11 (21.2) | | | | | | | | | |
Abbreviations: CVST, cerebral venous sinus thrombosis; GIT, gastrointestinal tract; PCOS, polycystic ovary syndrome; CNS, central nervous system; LOC, loss of consciousness; UMN, upper motor neuron; PNS, peripheral nervous system; NMS, neuromusculoskeletal; PSY, psychiatric; UVA, univariate analysis; MVA, multivariate analysis; OR, odds ratio; CI, confidence interval; Ref, reference |
1 Comparing severe cases to moderate cases. |
2 Comparing critical cases to moderate cases. |
3 Variables with frequency = 0 were not included in UVA; clinical outcome not included in UVA since it cannot be considered as potential predictor of severity. |
4 Selected variables with UVA P -value < 0.05 were included in MVA; MVA adjusted for age group, neurological comorbidities, non- neurological comorbidities, CNS presentations, PNS presentations, NMS presentations; using multinomial logistic regression model. |
5 Selected variables with UVA P -value < 0.05 were included in the MVA; MVA adjusted for gender, age group, neurological comorbidities, non- neurological comorbidities, CNS presentations, PNS presentations, NMS presentations; using multinomial logistic regression model. |
6 Reference category for UVA and MVA within this group variable; all other variables were dichotomous (Presence versus Absence); Presence = reference category, Absence = tabulated OR (95% CI). |
7 P -value < 0.05 was considered statistically significant. |
8 Patients were not mutually exclusive within this variable. |
Predictors Of Severity
Table 3 demonstrates that age group 20–39 years, as well as, absence of stroke, hypertension, diabetes, renal disease, cardiac disease, malignancy and altered LOC were predictors revealed to be significantly associated with lower odds of severity in univariate logistic regressions comparing severe to moderate and critical to moderate cases, whereas, higher odds of severity were associated with absence of anosmia and myalgia in both univariate comparisons. Additionally, univariate logistic regression for critical compared to moderate cases identified female gender (OR 2.07; CI 1.11–3.88; P = 0.022) as a predictor with increased odds of severity. In the severe to moderate multivariate logistic regression, those aged 20–29 years were found to have a low risk of severity independently (adjusted OR 0.02; CI 0.002–0.28; P = 0.003) when model was adjusted for age group; neurological and non- neurological comorbidities; CNS, PNS and NMS presentations. When comparing critical to moderate cases, after adjustment for gender; age group; neurological and non- neurological comorbidities; CNS, PNS and NMS presentations, multivariate logistic regression confirmed that females, age group 20–39 years and absence of non-neurological comorbidities were significant independent predictors of severity in Neuro-COVID patients. Females were twice as more likely to be critical than moderate (adjusted OR 2.67; CI 1.10–6.48; P = 0.030). Patients aged 20–39 years ([absence] adjusted OR 0.04; CI 0.003–0.62; P = 0.021) and those without non-neurological comorbidities ([absence] adjusted OR 0.14; CI 0.05–0.41; P < 0.001) exhibited lower risks of being critical than moderate. Moreover, CNS presentation was not an independent predictor of severity, unlike patients admitted with PNS manifestations ([absence] adjusted OR 19.54; CI 2.30-166.09; P = 0.006) and NMS manifestations ([absence] adjusted OR 4.35; CI 1.47–12.87; P = 0.008) complaints with less likelihood, 1/20 and ¼, respectively, to present as critical cases than moderate. (Table 3)
Clinical Findings According To Outcome
Figure 1 summaries the patient outcome indicating that the death rate was relatively higher in Neuro-COVID cases (13.6%) as compared to Non-Neuro-COVID cases (12.2%). Table 4 shows that out of 48 Neuro-COVID deaths, 28 (58.3%) females and 20 (41.7%) males died, although this was not statistically significant (P = 0.344). Half of the patients who died were aged 60–79 years (deaths = 50% versus discharges = 10.2%; P < 0.001) and majority of those discharged were 20–39 years (deaths = 16.7% versus discharges = 60.9%; P < 0.001). Patients with underlying comorbidities faced more deaths than discharges (deaths = 89.6% versus discharges = 38.8%; P < 0.001). Different parts of nervous system involved had a significant role on COVID outcome because more patients having CNS findings were found dead (deaths = 81.3% versus discharges = 41.1%; P < 0.001), whereas, merely few incidences of death were amongst those with PNS involvement (deaths = 2.1% versus discharges = 40.8%; P < 0.001) and NMS involvement (deaths = 33.3% versus discharge = 73.7%; P < 0.001). Inevitably, death rates were predominant in patients determined severe (deaths = 14.2% versus discharges = 7.2%; P < 0.001) and critical (deaths = 85.4% versus discharges = 3.6%; P < 0.001). (Table 4)
Table 4
Distribution of clinical findings for outcome and predictors of mortalities amongst Neuro-COVID patients.
Variable | Clinical Outcome | Deaths1 |
Deaths (n = 48) No. (%) | Discharges (n = 304) No. (%) | P -value | UVA2 OR (95% CI) | P -value | MVA3 OR (95% CI) | P -value |
Gender | | | | | | | |
Female | 28 (58.3) | 155 (51.0s) | 0.344 | 1.35 (0.73–2.49) | 0.345 | | |
Male4 | 20 (41.7) | 149 (49.0) | | Ref | | | |
Age group (years) | | | | | | | |
< 20 | 0 | 37 (12.2) | 0.0115 | - | - | | |
20–39 | 8 (16.7) | 185 (60.9) | < 0.0015 | 0.02 (0.003–0.10) | < 0.0015 | 0.19 (0.009–3.72) | 0.271 |
40–59 | 11 (22.9) | 49 (16.1) | 0.244 | 0.09 (0.02–0.53) | 0.0075 | 0.24 (0.01–4.58) | 0.339 |
60–79 | 24 (50.0) | 31 (10.2) | < 0.0015 | 0.31 (0.06–1.74) | 0.183 | 0.13 (0.007–2.27) | 0.161 |
≥ 804 | 5 (10.4) | 2 (0.7) | 0.0015 | Ref | | Ref | |
Comorbidities6 | 43 (89.6) | 118 (38.8) | < 0.0015 | 13.56 (5.22–35.21) | < 0.0015 | | |
Neurological | 10 (20.8) | 14 (4.6) | < 0.0015 | 5.45 (2.26–13.13) | < 0.0015 | 0.71 (0.17–3.07) | 0.650 |
Stroke | 6 (12.5) | 7 (2.3) | 0.0045 | 6.06 (1.94–18.90) | 0.0025 | | |
Brain/ spinal cord tumour | 2 (4.2) | 3 (1.0) | 0.139 | 4.36 (0.71–26.81) | 0.112 | | |
Epilepsy | 1 (2.1) | 0 | 0.136 | - | - | | |
Alzheimer | 1 (2.1) | 0 | 0.136 | - | - | | |
Hemiplegia | 0 | 1 (0.3) | 1.000 | - | - | | |
Cerebral palsy | 1 (2.1) | 0 | 0.136 | - | - | | |
Migraine | 0 | 1 (0.3) | 1.000 | - | - | | |
CVST | 0 | 1 (0.3) | 1.000 | - | - | | |
Myopathy | 1 (2.1) | 1 (0.3) | 0.254 | 6.45 (0.40–104.83) | 0.190 | | |
Psychiatric disorder | 1 (2.1) | 2 (0.7) | 0.357 | 3.21 (0.29–36.13) | 0.345 | | |
Non- Neurological | 43 (89.6) | 112 (38.8) | < 0.0015 | 14.74 (5.67–38.31) | < 0.0015 | 4.27 - (0.89–20.44) | 0.069 |
Hypertension | 22 (45.8) | 43 (14.1) | < 0.0015 | 5.14 (2.67–9.87) | < 0.0015 | | |
Diabetes | 18 (37.5) | 33 (10.9) | < 0.0015 | 4.93 (2.48–9.80) | < 0.0015 | | |
Asthma | 0 | 25 (8.2) | 0.0345 | - | - | | |
Chronic sinusitis | 0 | 12 (3.9) | 0.383 | - | - | | |
Renal disease | 13 (27.1) | 11 (3.6) | < 0.0015 | 9.90 (4.12–23.76) | < 0.0015 | | |
Cardiovascular disease | 9 (18.8) | 12 (3.9) | 0.0015 | 5.62 (2.22–14.18) | < 0.0015 | | |
Malignancy | 10 (20.8) | 5 (1.6) | < 0.0015 | 15.74 (5.11–48.49) | < 0.0015 | | |
Benign tumour | 0 | 2 (0.7) | 1.000 | - | - | | |
Liver disease | 7 (14.6) | 4 (1.3) | < 0.0015 | 12.81 (3.59–45.65) | < 0.0015 | | |
Blood disorders | 3 (6.3) | 6 (2.0) | 0.110 | 3.31 (0.80–13.71) | 0.099 | | |
GIT disease | 2 (4.2) | 7 (2.3) | 0.353 | 1.85 (0.37–9.15) | 0.454 | | |
Rheumatic disease | 4 (8.3) | 5 (1.6) | 0.0235 | 5.44 (1.41–21.02) | 0.0145 | | |
Thyroid disease | 0 | 3 (1.0) | 1.000 | - | - | | |
PCOS | 0 | 1 (0.3) | 1.000 | - | - | | |
Smoking | 5 (10.4) | 4 (1.3) | 0.0035 | 8.72 (2.25–33.74) | 0.0025 | | |
Substance abuse | 5 (10.4) | 2 (0.7) | 0.0015 | 17.56 (3.30–93.33) | 0.0015 | | |
Clinical Presentations6 | | | | | | | |
CNS | 39 (81.3) | 125 (41.1) | < 0.0015 | 6.21 (2.90–13.27) | < 0.0015 | 0.70 (0.10–4.80) | 0.717 |
Headache | 7 (14.6) | 93 (30.6) | 0.0225 | 0.39 (0.17–0.90) | 0.0275 | | |
Altered level of consciousness | 32 (66.7) | 24 (7.9) | < 0.0015 | 23.33 (11.24–48.45) | < 0.0015 | | |
Dizziness | 3 (6.3) | 9 (3.0) | 0.216 | 2.19 (0.57–8.38) | 0.254 | | |
Seizure | 2 (4.2) | 2 (0.7) | 0.091 | 6.57 (0.90–47.76) | 0.063 | | |
Paraparesis/ Paraplegia | 3 (6.3) | 1 (0.3) | 0.0095 | 20.20 (2.06–198.43) | 0.0105 | | |
Hemiparesis | 1 (2.1) | 0 | 0.136 | - | - | | |
Aphasia | 2 (4.2) | 0 | 0.0185 | - | - | | |
Dysarthria | 1 (2.1) | 1 (0.3) | 0.254 | 6.45 (0.40–104.83) | 0.190 | | |
UMN facial palsy | 1 (2.1) | 0 | 0.136 | - | - | | |
Unequal pupils | 1 (2.1) | 0 | 0.136 | - | - | | |
Signs of meningitis | 0 | 1 (0.3) | 1.000 | - | - | | |
Paraesthesia | 1 (2.1) | 2 (0.7) | 0.357 | 3.21 (0.27–36.13) | 0.345 | | |
Faecal incontinence | 2 (4.2) | 0 | 0.0185 | - | - | | |
Urinary retention | 1 (2.1) | 0 | 0.136 | - | - | | |
PNS | 1 (2.1) | 124 (40.8) | < 0.0015 | 0.03 (0.004–0.23) | 0.0015 | 0.25 (0.02–4.01) | 0.330 |
Anosmia | 1 (2.1) | 117 (38.5) | < 0.0015 | 0.03 (0.005–0.25) | 0.0015 | | |
Hyposmia | 0 | 3 (1.0) | 1.000 | - | - | | |
Ageusia | 0 | 80 (26.3) | < 0.0015 | - | - | | |
Hypogeusia | 0 | 4 (1.3) | 1.000 | - | - | | |
Blurred vision | 0 | 2 (0.7) | 1.000 | - | - | | |
NMS | 16 (33.3) | 224 (73.7) | < 0.0015 | 0.18 (0.09–0.34) | < 0.0015 | 0.65 (0.12–3.46) | 0.613 |
Myalgia | 15 (31.3) | 200 (65.8) | < 0.0015 | 0.24 (0.12–0.46) | < 0.0015 | | |
Arthralgia | 2 (4.2) | 41 (13.5) | 0.067 | 0.28 (0.07–1.19) | 0.085 | | |
PSY | 2 (4.2) | 2 (0.7) | 0.091 | 6.57 (0.90–47.76) | 0.063 | | |
Visual Hallucination | 1 (2.1) | 1 (0.3) | 0.254 | 6.45 (0.40–104.83) | 0.190 | | |
Agitation | 0 | 2 (0.7) | 1.000 | - | - | | |
Depressed mood | 0 | 1 (0.3) | 1.000 | - | - | | |
Insomnia | 0 | 1 (0.3) | 1.000 | - | - | | |
Suicidal thoughts | 0 | 1 (0.3) | 1.000 | - | - | | |
Psychosis | 1 (2.1) | 0 | 0.136 | - | - | | |
Disease Severity | | | | | | | |
Moderate | 0 | 271 (89.1) | < 0.0015 | - | - | | |
Severe4 | 7 (14.6) | 22 (7.2) | 0.093 | Ref | | Ref | |
Critical | 41 (85.4) | 11 (3.6) | < 0.0015 | 11.71 (3.98–34.49) | < 0.0015 | 12.06 (3.41–42.64) | < 0.005 |
Abbreviations: CVST, cerebral venous sinus thrombosis; GIT, gastrointestinal tract; PCOS, polycystic ovary syndrome; CNS, central nervous system; LOC, loss of consciousness; UMN, upper motor neuron; PNS, peripheral nervous system; NMS, neuromusculoskeletal; PSY, psychiatric; UVA, univariate analysis; MVA, multivariate analysis; OR, odds ratio; CI, confidence interval; Ref, reference |
1 Comparing deaths to discharges. |
2 Variables with frequency = 0 were not included in UVA. |
3 Selected variables with UVA P -value < 0.05 were included in MVA; MVA adjusted for age group, neurological comorbidities, non- neurological comorbidities, CNS presentations, PNS presentations, NMS presentations, disease severity; using multinomial logistic regression model. |
4 Reference category for UVA and MVA within this group variable; all other variables were dichotomous (Presence versus Absence); Absence = reference category, Presence = tabulated OR (95% CI). |
5 P -value < 0.05 was considered statistically significant. |
6 Patients were not mutually exclusive within this variable. |
Predictors Of Mortality
It is evident in Table 4 that univariate logistic regression demonstrated that significant predictors of mortality in Neuro-COVID patients with increased the risk of death included, any comorbidities (OR 13.56; CI 5.22–35.21; P < 0.001); neurological comorbidities (OR 5.45; CI 2.26–13.13; P < 0.001) specifically stroke (OR 6.06; CI 1.94–18.90; P = 0.002); non-neurological comorbidities (OR 14.74; CI 5.67–38.31; P < 0.001) including hypertension (OR 5.14; CI 2.67–9.87; P < 0.001), diabetes (OR 4.93; CI 2.48–9.80; P < 0.001), renal disease (OR 9.90; CI 4.12–23.76; P < 0.001), cardiovascular disease (OR 5.62; CI 2.22–14.18; P < 0.001), malignancy (OR 15.74; CI 5.11–48.49; P < 0.001), liver disease (OR 12.81; CI 3.59–45.65; P < 0.001), rheumatic disease (OR 5.44; CI 1.41–21.02; P = 0.014), smoking (OR 8.72; CI 2.25–33.74; P = 0.002) and substance abuse (OR 17.56; CI 3.30-93.33; P = 0.001); CNS presentations (OR 6.21; CI 2.90-13.27; P < 0.001) particularly altered LOC (OR 23.33; CI 11.24–48.45; P < 0.001) and paraparesis/paraplegia (OR 20.20; CI 2.06-198.43; P = 0.010); and disease severity (OR 11.71; CI 3.98–34.49; P < 0.001). Age group 20–39 years (OR 0.02; CI 0.003-0.10; P < 0.001) and 40–59 years (OR 0.09; CI 0.02–0.53; P = 0.007); headache (OR 0.39; CI 0.17–0.90; P = 0.027); PNS findings (OR 0.03; CI 0.004–0.23; P < 0.001) mainly anosmia (OR 0.03; CI 0.005–0.25; P < 0.001), as well as NMS findings (OR 0.18; CI 0.09–0.34; P < 0.001) mainly myalgia (OR 0.24; CI 0.12–0.46; P < 0.001) were significant predictors found to decrease the risk of mortality. None of PSY findings were predictors of mortality. Multivariate logistic regression was adjusted for age group; neurological and non- neurological comorbidities; CNS, PNS and NMS presentations and disease severity. However, only disease severity emerged as the significant predictor of mortality in Neuro-COVID patients independent to other variables, emphasising that critical cases with nervous system presentations manifested 12 times higher risk of death (adjusted OR 12.06; CI 3.41–42.64; P < 0.001) when compared to severe cases. (Table 4)
Table 5 summarizes the statistically significant clinical findings amongst Neuro-COVID patients.
Table 5
Summary of statistically significant clinical findings amongst Neuro-COVID patients.
Variable | Clinical Findings (n = 352) |
Comorbidities | Disease Severity | Clinical Outcome |
With % | Without % | Moderate % | Severe % | Critical % | Deaths % | Discharges % |
Age Group, (years) | | | | | | | |
< 20 | 5.0* | 15.2* | 13.7* | 0 | 0 | 0 | 12.2* |
20–39 | 34.8* | 71.7* | 64.9* | 27.6* | 17.3* | 16.7* | 60.9* |
40–59 | 24.8* | 10.5* | 15.1* | 27.6* | 21.2* | 22.9 | 16.1 |
60–79 | 31.7* | 2.1* | 5.9* | 37.9* | 53.8* | 50.0* | 10.2* |
≥ 80 | 3.7 | 0.5 | 0.4* | 6.9* | 7.7* | 10.4* | 0.7* |
Comorbidities** | | | | | | | |
Neurological | - | - | 2.6* | 17.2* | 23.1* | 20.8* | 4.6* |
Non- Neurological | - | - | 32.8* | 72.4* | 86.5* | 89.6* | 38.8* |
Clinical Presentations** | | | | | | | |
CNS | 58.4* | 36.6* | 38.0* | 58.6* | 84.6* | 81.3* | 41.1* |
PNS | 25.5* | 44.0* | 43.9* | 17.2* | 1.9* | 2.1* | 40.8* |
NMS | 57.2* | 77.5* | 76.8* | 55.2* | 30.8* | 33.3* | 73.7* |
PSY | 1.9 | 0.5 | 0 | 13.8* | 0 | 4.2 | 0.7 |
Disease Severity | | | | | | | |
Moderate | 57.1* | 93.7* | - | - | - | 0 | 89.1* |
Severe | 14.9* | 2.6* | - | - | - | 14.6 | 7.2 |
Critical | 28.0* | 3.7* | - | - | - | 85.4* | 3.6* |
Clinical Outcome | | | | | | | |
Deaths | 26.7* | 2.8* | 0 | 24.1* | 78.8* | - | - |
Discharges | 73.3* | 97.4* | 100.0* | 75.9* | 21.2* | - | - |
Variable (Predictor) | Predictors of Severity and Mortality |
Severe† | Critical†† | Deaths††† |
Univariate OR | Multivariate OR | Univariate OR | Multivariate OR | Univariate OR | Multivariate OR |
Gender | | | | | | |
Female | 0.82 | - | 2.07* | 2.67* | 1.35* | - |
Male | Ref ¶ | - | Ref ¶ | - | Ref ¶¶ | - |
Age Group, (years) | | | | | | |
< 20 | - | - | - | - | - | - |
20–39 | 0.02* | 0.04* | 0.01* | 0.04* | 0.02* | 0.19 |
40–59 | 0.10 | 0.10 | 0.07* | 0.08 | 0.09* | 0.24 |
60–79 | 0.34 | 0.22 | 0.44 | 0.26 | 0.31 | 0.13 |
≥ 80 ¶ | Ref ¶ | Ref ¶ | Ref ¶ | Ref ¶ | Ref ¶¶ | Ref ¶¶ |
Comorbidities** | | | | | | |
Neurological | 0.13* | 0.27 | 0.09* | 0.30 | 5.45* | 0.71 |
Non- Neurological | 0.17* | 0.40 | 0.08* | 0.14* | 14.74* | 4.27 |
Clinical Presentations** | | | | | | |
CNS | 0.043* | 0.87 | 0.11* | 0.47 | 6.21* | 0.70 |
PNS | 3.76* | 2.19 | 39.93* | 19.54* | 0.03* | 0.25 |
NMS | 2.68* | 1.90 | 7.43* | 4.35* | 0.18* | 0.65 |
PSY | - | - | - | - | 6.57 | - |
Disease Severity | | | | | | |
Moderate | - | - | - | - | - | - |
Severe | - | - | - | - | Ref ¶¶ | Ref ¶¶ |
Critical | - | - | - | - | 11.71 | 12.06 |
Abbreviations: CNS, central nervous system; PNS, peripheral nervous system; NMS, neuromusculoskeletal; PSY, psychiatric; OR, odds ratio; Ref, reference |
* P -value was < 0.05 and considered statistically significant. |
** Patients were not mutually exclusive within this variable. |
† Comparing severe cases to moderate cases; OR tabulated; refer to Table 3 for 95% confidence interval. |
†† Comparing critical cases to moderate cases; OR tabulated; refer to Table 3 for 95% confidence interval. |
††† Comparing deaths to discharges; OR tabulated; refer to Table 4 for 95% confidence interval |
¶ Reference category for univariate analysis and multivariate analysis within this group variable; all other variables were dichotomous (Presence versus Absence); Presence = reference category, Absence = tabulated OR. |
¶¶ Reference category for univariate analysis and multivariate analysis within this group variable; all other variables were dichotomous (Presence versus Absence); Absence = reference category, Presence = tabulated OR. |