A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City.

OBJECTIVE: To determine the prevalence and associated mortality of well-defined neurologic diagnoses among COVID-19 patients, we prospectively followed hospitalized SARS-Cov-2 positive patients and recorded new neurologic disorders and hospital outcomes METHODS: We conducted a prospective, multi-center, observational study of consecutive hospitalized adults in the NYC metropolitan area with laboratory-confirmed SARS-CoV-2 infection The prevalence of new neurologic disorders (as diagnosed by a neurologist) was recorded and in-hospital mortality and discharge disposition were compared between COVID-19 patients with and without neurologic disorders RESULTS: Of 4,491 COVID-19 patients hospitalized during the study timeframe, 606 (13 5%) developed a new neurologic disorder in a median of 2 days from COVID-19 symptom onset The most common diagnoses were: toxic/metabolic encephalopathy (6 8%), seizure (1 6%), stroke (1 9%), and hypoxic/ischemic injury (1 4%) No patient had meningitis/encephalitis, or myelopathy/myelitis referable to SARS-CoV-2 infection and 18/18 CSF specimens were RT-PCR negative for SARS-CoV-2 Patients with neurologic disorders were more often older, male, white, hypertensive, diabetic, intubated, and had higher sequential organ failure assessment (SOFA) scores (all P<0 05) After adjusting for age, sex, SOFA-scores, intubation, past history, medical complications, medications and comfort-care-status, COVID-19 patients with neurologic disorders had increased risk of in-hospital mortality (Hazard Ratio[HR] 1 38, 95% CI 1 17-1 62, P<0 001) and decreased likelihood of discharge home (HR 0 72, 95% CI 0 63-0 85, P<0 001) CONCLUSIONS: Neurologic disorders were detected in 13 5% of COVID-19 patients and were associated with increased risk of in-hospital mortality and decreased likelihood of discharge home Many observed neurologic disorders may be sequelae of severe systemic illness