Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up
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Abstract
Objective
To systematically describe central (CNS) and peripheral (PNS) nervous system complications in hospitalized COVID-19 patients.
Methods
We conducted a prospective, consecutive, observational study of adult patients from a tertiary referral center with confirmed COVID-19. All patients were screened daily for neurological and neuropsychiatric symptoms during admission and discharge. Three-month follow-up data were collected using electronic health records. We classified complications as caused by SARS-CoV-2 neurotropism, immune-mediated or critical illness-related.
Results
From April to September 2020, we enrolled 61 consecutively admitted COVID-19 patients, 35 (57%) of whom required intensive care (ICU) management for respiratory failure. Forty-one CNS/PNS complications were identified in 28 of 61 (45.9%) patients and were more frequent in ICU compared to non-ICU patients. The most common CNS complication was encephalopathy ( n = 19, 31.1%), which was severe in 13 patients (GCS ≤ 12), including 8 with akinetic mutism. Length of ICU admission was independently associated with encephalopathy (OR = 1.22). Other CNS complications included ischemic stroke, a biopsy-proven acute necrotizing encephalitis, and transverse myelitis. The most common PNS complication was critical illness polyneuromyopathy (13.1%), with prolonged ICU stay as independent predictor (OR = 1.14). Treatment-related PNS complications included meralgia paresthetica. Of 41 complications in total, 3 were para/post-infectious, 34 were secondary to critical illness or other causes, and 4 remained unresolved. Cerebrospinal fluid was negative for SARS-CoV-2 RNA in all 5 patients investigated.
Conclusion
CNS and PNS complications were common in hospitalized COVID-19 patients, particularly in the ICU, and often attributable to critical illness. When COVID-19 was the primary cause for neurological disease, no signs of viral neurotropism were detected, but laboratory changes suggested autoimmune-mediated mechanisms.
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SciScore for 10.1101/2020.11.15.20231001: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: 2.7 Ethics statement: The Ethics Committee of the Capital Region of Denmark approved the study and waived the need for written consent because the risks were deemed negligible (reference j.nr. 20025838).
Consent: 2.7 Ethics statement: The Ethics Committee of the Capital Region of Denmark approved the study and waived the need for written consent because the risks were deemed negligible (reference j.nr. 20025838).Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources All included patients had positive SARS-CoV-2 polymerase-chain reaction (PCR) by … SciScore for 10.1101/2020.11.15.20231001: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: 2.7 Ethics statement: The Ethics Committee of the Capital Region of Denmark approved the study and waived the need for written consent because the risks were deemed negligible (reference j.nr. 20025838).
Consent: 2.7 Ethics statement: The Ethics Committee of the Capital Region of Denmark approved the study and waived the need for written consent because the risks were deemed negligible (reference j.nr. 20025838).Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Antibodies Sentences Resources All included patients had positive SARS-CoV-2 polymerase-chain reaction (PCR) by nasopharyngeal/tracheal testing, except for 1 patient in whom a clinical suspicion of COVID-19 was confirmed 27 days after symptom onset by a strongly positive SARS-CoV-2 IgG antibody titer. SARS-CoV-2 IgGsuggested: NoneSoftware and Algorithms Sentences Resources All analyses were performed using Stata/IC 15.1 (StataCorp. 2017, College Station, TX). StataCorpsuggested: (Stata, RRID:SCR_012763)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:As to limitations, our cohort size was small, owing to the comparatively low burden of COVID-19 in the general population in Denmark in early 2020 [40]; patients were highly selected as ours is a tertiary referral center, which limits the generalizability of our findings; not all patients were sufficiently investigated; and we did not include a control group of non-COVID-19 patients. Future case-control studies are necessary to determine if SARS-CoV-2 infections are causal or coincidental and if complications are indeed more prevalent in COVID-19 patients compared to non-COVID-19 patients.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a protocol registration statement.
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