Neurological diagnoses in hospitalized COVID-19 patients associated with adverse outcomes

Authors

• Meghan R Hutch, Northwestern University
• Jiyeon Son, University of Pittsburgh
• Trang T Le, Perelman School of Medicine, University of Pennsylvania
• Chuan Hong, Duke University
• Xuan Wang, University of Utah
• Zahra Shakeri Hossein Abad, Harvard Medical School
• Michele Morris, University of Pittsburgh
• Alba Gutiérrez-Sacristán, Harvard Medical School
• Jeffrey G Klann, Massachusetts General Hospital
• Anastasia Spiridou, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust
• Ashley Batugo, Perelman School of Medicine, University of Pennsylvania
• Riccardo Bellazzi, University of Pavia
• Vincent Benoit, APHP Greater Paris University Hospital
• Clara-Lea Bonzel, Harvard Medical School
• William A Bryant, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust
• Lorenzo Chiudinelli, UOC Ricerca
• Kelly Cho, Population Health and Data Science
• Priyam Das, Harvard Medical School
• Tomás González González, Wellcome Trust Scottish Health Informatics Programme
• David A Hanauer, University of Michigan Medical School
• Darren W Henderson, University of Kentucky
• Yuk-Lam Ho, Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC)
• Ne Hooi Will Loh, National University Health System
• Adeline Makoudjou, University of Freiburg
• Simran Makwana, Harvard Medical School
• Alberto Malovini, Laboratory of Informatics and Systems Engineering for Clinical Research
• Bertrand Moal, Bordeaux University Hospital / CHU de Bordeaux

Abstract

Few studies examining the patient outcomes of concurrent neurological manifestations during acute COVID-19 leveraged multinational cohorts of adults and children or distinguished between central and peripheral nervous system (CNS vs. PNS) involvement. Using a federated multinational network in which local clinicians and informatics experts curated the electronic health records data, we evaluated the risk of prolonged hospitalization and mortality in hospitalized COVID-19 patients from 21 healthcare systems across 7 countries. For adults, we used a federated learning approach whereby we ran Cox proportional hazard models locally at each healthcare system and performed a meta-analysis on the aggregated results to estimate the overall risk of adverse outcomes across our geographically diverse populations. For children, we reported descriptive statistics separately due to their low frequency of neurological involvement and poor outcomes. Among the 106,229 hospitalized COVID-19 patients (104,031 patients ≥18 years; 2,198 patients <18 years, January 2020-October 2021), 15,101 (14%) had at least one CNS diagnosis, while 2,788 (3%) had at least one PNS diagnosis. After controlling for demographics and pre-existing conditions, adults with CNS involvement had longer hospital stay (11 versus 6 days) and greater risk of (Hazard Ratio = 1.78) and faster time to death (12 versus 24 days) than patients with no neurological condition (NNC) during acute COVID-19 hospitalization. Adults with PNS involvement also had longer hospital stay but lower risk of mortality than the NNC group. Although children had a low frequency of neurological involvement during COVID-19 hospitalization, a substantially higher proportion of children with CNS involvement died compared to those with NNC (6% vs 1%). Overall, patients with concurrent CNS manifestation during acute COVID-19 hospitalization faced greater risks for adverse clinical outcomes than patients without any neurological diagnosis. Our global informatics framework using a federated approach (versus a centralized data collection approach) has utility for clinical discovery beyond COVID-19.

Document Type

Article

Publication Date

4-1-2024

Notes/Citation Information

Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Digital Object Identifier (DOI)

10.1371/journal.pdig.0000484

Archival?

Archival

Repository Citation

Hutch, Meghan R; Son, Jiyeon; Le, Trang T; Hong, Chuan; Wang, Xuan; Shakeri Hossein Abad, Zahra; Morris, Michele; Gutiérrez-Sacristán, Alba; Klann, Jeffrey G; Spiridou, Anastasia; Batugo, Ashley; Bellazzi, Riccardo; Benoit, Vincent; Bonzel, Clara-Lea; Bryant, William A; Chiudinelli, Lorenzo; Cho, Kelly; Das, Priyam; González González, Tomás; Hanauer, David A; Henderson, Darren W; Ho, Yuk-Lam; Loh, Ne Hooi Will; Makoudjou, Adeline; Makwana, Simran; Malovini, Alberto; and Moal, Bertrand, "Neurological diagnoses in hospitalized COVID-19 patients associated with adverse outcomes" (2024). Biostatistics Faculty Publications. 170.
https://uknowledge.uky.edu/biostatistics_facpub/170