Clinical outcome of neurological patients with COVID-19: the impact of healthcare organization improvement between waves

  1. Viviana Cristillo
  2. Andrea Pilotto
  3. Alberto Benussi
  4. Ilenia Libri
  5. Marcello Giunta
  6. Andrea Morotti
  7. Stefano Gipponi
  8. Martina Locatelli
  9. Stefano Cotti Piccinelli
  10. Valentina Mazzoleni
  11. Francesca Schiano di Cola
  12. Stefano Masciocchi
  13. Debora Pezzini
  14. Andrea Scalvini
  15. Enrico Premi
  16. Elisabetta Cottini
  17. Massimo Gamba
  18. Mauro Magoni
  19. Marco Maria Fontanella
  20. Alessandro Padovani

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Abstract

Objective

The aim of this study is to evaluate the differences in clinical presentations and the impact of healthcare organization on outcomes of neurological COVID-19 patients admitted during the first and second pandemic waves.

Methods

In this single-center cohort study, we included all patients with SARS-CoV-2 infection admitted to a Neuro-COVID Unit. Demographic, clinical, and laboratory data were compared between patients admitted during the first and second waves of the COVID-19 pandemic.

Results

Two hundred twenty-three patients were included, of whom 112 and 111 were hospitalized during the first and second pandemic waves, respectively. Patients admitted during the second wave were younger and exhibited pulmonary COVID-19 severity, resulting in less oxygen support ( n  = 41, 36.9% vs n  = 79, 70.5%, p  < 0.001) and lower mortality rates (14.4% vs 31.3%, p  = 0.004). The different healthcare strategies and early steroid treatment emerged as significant predictors of mortality independently from age, pre-morbid conditions and COVID-19 severity in Cox regression analyses.

Conclusions

Differences in healthcare strategies during the second phase of the COVID-19 pandemic probably explain the differences in clinical outcomes independently of disease severity, underlying the importance of standardized early management of neurological patients with SARS-CoV-2 infection.

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  1. Version published to 10.1007/s10072-022-05946-8
  2. ScreenIT

    SciScore for 10.1101/2021.11.19.21266606: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The study received approval from local ethics committee of the ASST Spedali Civili Hospital, Brescia (NP 4067, approved 08.05. 2020).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    A two-sided p-value<0.05 was considered significant; data analyses were carried out using SPSS software (version 21.0).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    We acknowledge that this work entails some limitations, as this is a monocentric study with a relative small sample size and we could not exclude that some patients with COVID-19 disease and neurological symptoms or syndromes did escape the referral, especially for mild cases not requiring hospitalization. Nevertheless, this is the first study evaluating the differences between neurological COVID-19 patients during the two pandemic waves. Findings showed that different management strategies adopted and the lessons learned by health workers from the first pandemic phases largely explain the improvement in final outcomes observed independently from the reduction of severity of SARS-CoV-2 infection. Larger on-going multicenter studies are warranted to confirm and extend these findings in order to understand the future global impact of healthcare system organization, immunomodulator treatments and the large use of vaccination on the outcome of neurological patients with COVID-19 disease.

    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.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.11.19.21266606v1 on medRxiv