Clinical characteristics and outcomes of inpatients with neurologic disease and COVID 19 in Brescia, Lombardy, Italy
Objective To report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID 19) Methods In this retrospective, single center cohort study, we included all adult inpatients with confirmed COVID 19 admitted to a neuro COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID 19 admitted in the same period. Results One hundred seventy three patients were included in this study, of whom 56 were positive and 117 were negative for COVID 19. Patients with COVID 19 were older (77.0 years, interquartile range [IQR] 67.0 83.8 years vs 70.1 years, IQR 52.9 78.6 years, p 0.006) had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n 43, 76.8% vs n 68, 58.1% and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7 1.1 vs 0.5, IQR 0.4 0.6, p 0.006) In hospital mortality rates (n 21, 37.5% vs n 5, 4.3% p 0.001) and incident delirium (n 15, 26.8% vs n 9, 7.7% p 0.003) were significantly higher in the COVID 19 group. Patients with COVID 19 and without COVID with stroke had similar baseline characteristics, but patients with COVID 19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0 6.0 vs 2.0, IQR 1.0 3.0, p 0.001) with a significantly lower number of patients with a good outcome (n 11, 25.6% vs n 48, 70.6% p 0.001) In patients with COVID 19, multivariable regressions showed increasing odds of in hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21 16.5, p 0.025) lower platelet count (OR 0.98, 95% CI 0.97 0.99, p 0.005) and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00 1.03, p 0.009) on admission. Conclusions Patients with COVID 19 admitted with neurologic disease, including stroke, have a significantly higher in hospital mortality and incident delirium and higher disability than patients without COVID 19.
Neurology