Multinational Prevalence of Neurological Phenotypes in Patients Hospitalized with COVID-19
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Abstract
OBJECTIVE
Neurological complications can worsen outcomes in COVID-19. We defined the prevalence of a wide range of neurological conditions among patients hospitalized with COVID-19 in geographically diverse multinational populations.
METHODS
Using electronic health record (EHR) data from 348 participating hospitals across 6 countries and 3 continents between January and September 2020, we performed a cross-sectional study of hospitalized adult and pediatric patients with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test, both with and without severe COVID-19. We assessed the frequency of each disease category and 3-character International Classification of Disease (ICD) code of neurological diseases by countries, sites, time before and after admission for COVID-19, and COVID-19 severity.
RESULTS
Among the 35,177 hospitalized patients with SARS-CoV-2 infection, there was increased prevalence of disorders of consciousness (5.8%, 95% confidence interval [CI]: 3.7%-7.8%, p FDR <.001) and unspecified disorders of the brain (8.1%, 95%CI: 5.7%-10.5%, p FDR <.001), compared to pre-admission prevalence. During hospitalization, patients who experienced severe COVID-19 status had 22% (95%CI: 19%-25%) increase in the relative risk (RR) of disorders of consciousness, 24% (95%CI: 13%-35%) increase in other cerebrovascular diseases, 34% (95%CI: 20%-50%) increase in nontraumatic intracranial hemorrhage, 37% (95%CI: 17%-60%) increase in encephalitis and/or myelitis, and 72% (95%CI: 67%-77%) increase in myopathy compared to those who never experienced severe disease.
INTERPRETATION
Using an international network and common EHR data elements, we highlight an increase in the prevalence of central and peripheral neurological phenotypes in patients hospitalized with SARS-CoV-2 infection, particularly among those with severe disease.
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SciScore for 10.1101/2021.01.27.21249817: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The institutional review board of each participating site approved the sharing of anonymous, aggregate data in compliance with multi-national patient privacy laws exempting the requirement for individual patient consent.
Consent: The institutional review board of each participating site approved the sharing of anonymous, aggregate data in compliance with multi-national patient privacy laws exempting the requirement for individual patient consent.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Res…SciScore for 10.1101/2021.01.27.21249817: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The institutional review board of each participating site approved the sharing of anonymous, aggregate data in compliance with multi-national patient privacy laws exempting the requirement for individual patient consent.
Consent: The institutional review board of each participating site approved the sharing of anonymous, aggregate data in compliance with multi-national patient privacy laws exempting the requirement for individual patient consent.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has limitations as the result of trade-offs to standardize data collection from multinational sites while strictly preserving patient privacy and adhering to multinational privacy laws across all contributing sites. First, this study relied on ICD codes that may not capture fully or accurately the disease phenotypes, particularly for conditions better documented in clinical notes. To standardize collection of ICD codes across contributing sites and to mitigate coding discrepancies, we used ICD codes at the categorical level (e.g., the first 3 alphanumeric characters before the decimal point for ICD-10). Thus, further characterization of certain conditions such as “other disorders of the brain” was not feasible at this stage. Second, the proportions of severe cases varied across sites. Adding the number of patients from all sites for each ICD code retained statistical power in the severity analysis, though data from the larger sites likely drove the findings. Third, because we aggregated data across sites, we were unable to consolidate all related ICD codes (e.g., organizing into PheCode38) at the individual patient level. The 4CE consortium is addressing these issues to prepare for the next phase of the analyses by developing a framework for conducting patient-level analyses at each site. Fourth, we might not have captured all pre-admission EHR data if patients did not receive all of their care in the same hospital system as the COVID-19 admission. This is a limitat...
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.
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