Neuro-COVID frequency and short-term outcome in the northern Portuguese population.

BACKGROUND COVID-19 related acute neurological phenotypes are being increasingly recognized, with neurological complications reported in over 30% of hospitalized patients. However, multicentric studies providing a population-based perspective are lacking. METHODS We conducted a retrospective multicentric study in five hospitals in Northern Portugal, representing 45.1% of all hospitalized patients in this region, between March 1st and June 30th , 2020. RESULTS Among 1261 hospitalized COVID-19 patients, 457 (36.2%) presented neurological manifestations, corresponding to a rate of 357 per 1000 in the Northern Region. Patients with neurologic manifestations were younger (68.0 vs. 71.2 years, p=0.002), and the most frequent neurological symptoms were headache (13.4%), delirium (10.1%) and impairment of consciousness (9.7%). Acute well-defined CNS involvement was found in 19.1% of patients, corresponding to a rate of 217 per 1000 hospitalized patients in the whole region. Admitting that all patients with severe neurological events were hospitalized, we extrapolated our results to all COVID-19 patients in the region, estimating that 116 will have a severe neurological event, corresponding to a rate of 9 per 1000 (7-11). Overall case-fatality in patients presenting neurological manifestations was 19.8%, increasing to 32.6% among those with acute well-defined CNS involvement. CONCLUSIONS We characterized the population of hospitalized COVID-19 patients in northern Portugal and found that neurological symptoms are common and associated with a high degree of disability at discharge. CNS involvement with criteria for in-hospital admission was observed in a significant proportion of patients. This knowledge provides the tools for adequate health planning and for improving COVID-19 multidisciplinary patient care.