From: Neurological manifestations in hospitalized COVID-19 patients: a cross-sectional study
Total (n = 157) | In-hospital death (n = 69) | Discharged or transferred (n = 88) | P-value | |
---|---|---|---|---|
Age (years) (mean ± SD) | 62.91 ± 91 (19–99) | 64.8 ± 17.3 (28–99) | 61.43 ± 16.35 (19–93) | 0.2 |
Age group (years), n (%) | ||||
< 20 | 1 (0.6%) | 0 | 1 (1.1%) | |
20–40 | 13 (8.3%) | 7 (10.1%) | 6 (6.8%) | |
40–60 | 40 (25.5%) | 16 (23.2%) | 24 (27.3%) | 0.8 |
> 60 | 103 (65%) | 44 (66.7%) | 57 (64.8%) | |
Gender N (%) | ||||
Male | 90 (57.3%) | 39 (56.5%/) | 51 (58.7%) | 0.85 |
Female | 67 (42.7%) | 30 (43.5%) | 17 (19.3%) | |
COVID-19 diagnosis | ||||
Definite | 89 (56.7%) | 41 (59.5%) | 48 (54.5%) | 0.008 |
Probable | 45 (28.7%) | 28 (40.5%) | 17 (23%) | |
Possible | 23 (14.6%) | 0 | 23 (26.5%) | |
Duration of hospitalization (days) (mean ± SD) | 10.44 ± 8.43 | 10.04 ± 8.42 (1–40) | 10.75 ± 8.47 (1–43) | 0.6 |
Onset time of neurologic presentation, n (%) | ||||
At the onset of COVID-19 symptoms | 47 (29.9%) | 21 (30.4%) | 26 (29.5%) | |
Several days after COVID-19 symptoms | 77 (49%) | 36 (52.2%) | 41 (46.6%) | |
Several weeks after COVID-19 symptoms | 11 (7%) | 2 (2.9%) | 9 (10.2%) | 0.73 |
Before clinical signs and symptoms of COVID-19 | 22 (12%) | 10 (14.5%) | 12 (13.6%) | |
Department of admission, n (%) | ||||
Neurology | 26 (16.6%) | 0 | 26 (29.5%) | |
COVID-19 intensive care unit | 47 (29.9%) | 41 (59.4%) | 6 (6.8%) | |
Internal medicine | 41 (26.1%) | 8 (11.6%) | 33 (37.5%) | < 0.001 |
Neurosurgery | 4 (2.5%) | 2 (2.9%) | 2 (2.3%) | |
Emergency | 20 (12.7%) | 10 (14.5%) | 10 (11.4%) | |
Stroke care unit | 19 (12.1%) | 8 (11.6%) | 11 (12.5%) | |
Comorbidities, n (%) | ||||
Hypertension | 112 (71.3%) | 52 (75.4%) | 60 (68.2%) | |
Diabetes mellitus | 58 (36.9%) | 29 (42%) | 29 (33%) | |
Atrial fibrillation | 7 (4.5%) | 2 (2.9%) | 5 (5.7%) | |
Heart disease | 20 (12.7%) | 8 (11.6) | 12 (136.6%) | |
Chronic obstructive pulmonary disease | 1 (0.6%) | 0 | 1 (1.1%) | |
End-stage renal disease | 2 (1.3%) | 2 (2.9%) | 0 | |
Rheumatologic disorder | 3 (1.9%) | 2 (2.9%) | 1 (1.1%) | > 0.05 |
Malignancy | 3 (1.9%) | 1 (1.4%) | 2 (2.3%) | |
Tobacco smoking | 16 (10.2%) | 4 (5.8%) | 12 (13.6%) | |
Opium addiction | 4 (2.5%) | 0 | 4 (4.5%) | |
Respiratory symptom presentation, n (%) | ||||
Cough | 38 (24.2%) | 11 (15.9%) | 27 (30.7%) | |
Fever | 37 (23.6%) | 14 (20.3%) | 23 (26.1%) | |
Dyspnea | 59 (37.6%) | 38 (55.1%) | 21 (23.9%) | |
Myalgia | 4 (2.5%) | 1 (1.4%) | 3 (3.4%) | 0.18 |
Headache | 5 (3.2%) | 0 | 5 (5.7%) | |
None | 14 (8.9%) | 5 (7.2%) | 9 (10.2%) | |
Neurological symptom presentation, n (%) | ||||
Loss of consciousness | 42 (26.8%) | 32 (46.6%) | 10 (11.4%) | |
Focal neurological deficit | 76 (48.4%) | 29 (42%) | 46 (52.3%) | |
Ataxia | 2 (1.3%) | 0 | 3 (3.4%) | |
Headache | 3 (1.9%) | 1 (1.4%) | 2 (2.3%) | |
Seizure | 7 (4.5%) | 3 (4.3%) | 4 (4.5%) | 0.16 |
Status epilepticus | 2 (1.3%) | 1 (1.4%) | 1 (1.1%) | |
Abnormal movement (myoclonus and tremor) | 1 (0.6%) | 0 | 1 (1.1%) | |
Muscle weakness | 16 (10.19%) | 2 (2.9%) | 14 (15.9%) | |
Visual loss | 3 (1.9%) | 0 | 3 (3.4%) | |
Vertigo | 2 (1.3%) | 0 | 2 (2.3%) | |
Cognitive disorder | 4 (2.5%) | 1 (1.4%) | 3 (3.4%) | |
Neurologic disorders, n (%) | ||||
Encephalopathy (any type) | 14 (8.9%) | 11 (15.9%) | 3 (3.4%) | |
Cerebrovascular disorder (any type) | ||||
Ischemic/transient ischemic attack | 85 (54.1%) | 36 (52.2%) | 44 (57.7%) | 0.99 |
Intracerebral/intraventricular hemorrhage | 24 (15.3%) | 12 (7.4%) | 12 (13.6%) | |
Spontaneous subarachnoid hemorrhage | 2 (1.3%) | 1 (1.4%) | 1 (1.1) | |
Subdural hematoma | 1 (0.6%) | 1 (1.4%) | 0 | |
Sinuous vein thrombosis | 2 (1.3%) | 1 (1.4%) | 1 (1.1) | |
Seizure (clinical or electrographic) | 4 (2.5%) | 2 (2.9%) | 2 (2.3%) | |
Movement disorder | 1 (0.6%) | 0 | 1 (1.1) | |
Neuroleptic malignant syndrome | 1 (0.6%) | 0 | 1 (1.1) | |
Peripheral nerve system | ||||
Guillain–Barre syndrome | 10 (6.4%) | 2 (2.9%) | 8 (9.1%) | |
Myopathy | 1 (0.6%) | 0 | 1 (1.1%) | |
Exacerbation of myasthenia gravis | 6 (3.8%) | 1 (1.4%) | 5 (5.7%) | |
Encephalitis/meningitis | 4 (2.5%) | 1 (1.4%) | 3 (3.4%) | |
Demyelinating disease | 2 (1.3%) | 1 (1.4%) | 1 (1.1%) | |
Past neurologic history, n (%) | ||||
None | 108 (68.8%) | 43 (62.3%) | 65 (73.9%) | |
Ischemic stroke | 32 (20.4%) | 18 (26.1%) | 14 (15.9%) | |
Intracerebral or intraventricular hemorrhage | 2 (1.2%) | 1 (1.4%) | 1 (1.1) | |
Dementia | 6 (3.8%) | 5 (7.2%) | 1 (1.1%) | |
Demyelinating disease/multiple sclerosis | 2 (1.2%) | 1 (1.4%) | 1 (1.1%) | |
Myasthenia gravis | 6 (3.8%) | 1 (1.4%) | 5 (5.7%) | |
Parkinson's and Parkinson-plus syndromes | 1 (0.6%) | 0 | 1 (1.1%) | |
Chest CT severity score (0–20) (mean ± SD) | 8.26 ± 4.4 (1–19) | 9.98 ± 4.52 (1–19) | 6.9 ± 3.8 (1–19) | < 0.001 |
History of immunosuppression use, n (%) | 13 (8.3%) | 5 (7.2%) | 8 (9.1%) | 0.68 |
History of corticosteroid use, n (%) | 12 (7.6%) | 5 (7.2%) | 7 (8%) | 0.86 |
Morbidity | ||||
Acute renal failure | 12 (7.6%) | 8 (11.6%) | 4 (4.5%) | |
Sepsis | 10 (6.4%) | 10 (14.5) | 0 | |
Electrolyte disorders | 5 (3.2%) | 4 (5.8%) | 1 (1.1) | |
Anemia | 7 (4.5%) | 3 (4.3%) | 4 (4.5) | |
Thrombocytopenia | 6 (3.8%) | 5 (7.2%) | 1 (1.1) | < 0.001 |
Deep vein thrombosis | 2 (1.3%) | 2 (2.9%) | 0 | |
Pulmonary embolism | 12 (7.6%) | 11 (15.9%) | 1 (1.1) | |
Urinary tract infections | 1 (0.6%) | 1 (1.4%) | 0 | |
Heparin-induced thrombocytopenia | 1 (0.6%) | 1 (1.4%) | 0 | |
Gastrointestinal bleeding | 1 (0.6%) | 0 | 1 (1.1) | |
Invasive mechanical ventilation, n (%) | 81 (51.6%) | 65 (94.2%) | 16 (18.2%) | < 0.001 |
Laboratory findings upon admission | ||||
White blood cells (cells/µL) | 10,988.78 ± 3892.49 (1100–25,000) | 12,023.19 ± 4588.22 (1100–25,000) | 10,168.39 ± 3020.42 (4000–18,000) | 0.003 |
Platelets (cells/1L) | 190,175.64 ± 85,545.86 (10,500–440,000) | 164,752.17 ± 82,826.7 (27,000–368,000) | 210,339.08 ± 82,675.94 (10,500–440,000) | 0.001 |
Hemoglobin (g/dl) | 10.88 ± 2.08 (4.3–16.6) | 10.28 ± 2.1 (4.3–15) | 11.37 ± 1.9 (6.5–16.6) | |
Erythrocyte sedimentation rate (mm/h) | 34.88 ± 21.74 | 37.19 ± 21 (5–95) | 32.82 ± 22.26 (5–91) | 0.001 |
C-reactive protein | ||||
(−) | 49 (31.2%) | 20 (29%) | 29 (33%) | 0.7 |
( +) | 48 (30.6%) | 24 (34.8%) | 24 (27.3%) | |
(+ +) | 16 (10.2%) | 12 (17.4%) | 4 (4.5%) | 0.2 |
(+ + +) | 17 (10.8%) | 5 (7.2%) | 12 (13.6%) | |
Creatine phosphokinase (U/L) | 289.13 ± 379.17 (24–2884) | 370.06 ± 235 (0–2884) | 225.75 ± 232.39 (24–1296) | 0.04 |
Aspartate aminotransferase (U/L) | 54.92 ± 44.78 (15–367) | 64.2 ± 58.19 (15.367) | 47 ± 26.7(16–145) | 0.02 |
Alanine transaminase (U/L) | 42.63 ± 36.92 (7–290) | 45.34 ± 45 (8–290) | 40.32 ± 28.32(7–133) | 0.42 |
Alkaline phosphatase (U/L) | 212.94 ± 99.69 (35–640) | 233.17 ± 118.63 (50–640) | 195.67 ± 76.79(35–550) | 0.02 |
Prothrombin time (s) | 13.80 ± 3.01(12–31) | 13.84 ± 3.03 (12–30) | 13.7 ± 3.01(12–31) | 0.89 |
Activated partial thromboplastin time (s) | 36.35 ± 10.97 (12–100) | 36.51 ± 7.9 (13–62) | 36.2 ± 12.9 (12–100) | 0.87 |
International normalized ratio | 1.26 ± 0.32 (1–3.7) | 1.26 ± 0.3 (1–2.4) | 1.26 ± 0.34 (1–3.7) | 0.9 |
Sodium (mEq/L) | 140.97 ± 7.24 (126–179) | 141.9 ± 8.1 (126–173) | 140.23 ± 6.25 (130–179) | 0.15 |
Potassium (mmol/L) | 4.1 ± 0.6 (2.7–6.6) | 4.1 ± 0.88 (2.7–6.6) | 4.05 ± 0.43 (3–5.5) | 0.3 |
Calcium (mmol/L) | 8.45 ± 0.85 (6–11.8) | 8.3 ± 0.86 (6–10.6) | 8.45 ± 0.85 (6.7–11.8) | 0.17 |
Lactate dehydrogenase (U/L) | 982.60 ± 1142.99 (303–9871) | 1158.91 ± 1441.54 (321–9871) | 832.91 ± 793 (303–5931) | 0.16 |
Blood urea nitrogen (mg/dL) | 32.42 ± 31.21(6–213) | 42.56 ± 40.5 (6–213) | 24.41 ± 17.6 (6–103) | 0.00 |
Creatinine (mg/dL) | 1.57 ± 1.4 (0.5–9.3) | 1.92 ± 1.9 (0.6–9.3) | 1.29 ± 0.67 (0.5–4.5) | 0.005 |
Blood sugar (mmol/L) | 183.40 ± 91.15 (41–650) | 203.04 ± 103.45 (75–650) | 167.3 ± 76.6 (41–395) | 0.017 |
Troponin | ||||
Negative | 134 (85.4%) | 51 (73.9%) | 83 (94.3%) | |
Weakly positive | 18 (11.5%) | 14 (20.3%) | 4 (4.5%) | 0.03 |
Positive | 4 (2.5%) | 3 (4.3%) | 1 (1.1%) | |
D-dimer | ||||
High | 46 (29.3%) | 27 (39.1%) | 19 (21.6%) | 0.03 |
Blood culture | ||||
Pseudomonas aeruginosa | 4 (2.5%) | 4 (5.8%) | 0 | |
Staph-coagulase negative | 2 (1.3%) | 2 (2.9%) | 0 | 0.4 |
Klebsiella | 8 (5.1%) | 7 (10.1%) | 1 (1.1%) |