Background and objectives: A variety of neurologic disorders have been reported as presentations or complications of coronavirus disease 2019 (COVID-19) infection. The objective of this study was to determine their incidence dynamics and long-term functional outcome. Methods: The Neuro-COVID Italy study was a multicenter, observational, cohort study with ambispective recruitment and prospective follow-up. Consecutive hospitalized patients presenting new neurologic disorders associated with COVID-19 infection (neuro-COVID), independently from respiratory severity, were systematically screened and actively recruited by neurology specialists in 38 centers in Italy and the Republic of San Marino. The primary outcomes were incidence of neuro-COVID cases during the first 70 weeks of the pandemic (March 2020-June 2021) and long-term functional outcome at 6 months, categorized as full recovery, mild symptoms, disabling symptoms, or death. Results: Among 52,759 hospitalized patients with COVID-19, 1,865 patients presenting 2,881 new neurologic disorders associated with COVID-19 infection (neuro-COVID) were recruited. The incidence of neuro-COVID cases significantly declined over time, comparing the first 3 pandemic waves (8.4%, 95% CI 7.9-8.9; 5.0%, 95% CI 4.7-5.3; 3.3%, 95% CI 3.0-3.6, respectively; p = 0.027). The most frequent neurologic disorders were acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), acute ischemic stroke (18.4%), and cognitive impairment (13.7%). The onset of neurologic disorders was more common in the prodromic phase (44.3%) or during the acute respiratory illness (40.9%), except for cognitive impairment whose onset prevailed during recovery (48.4%). A good functional outcome was achieved by most patients with neuro-COVID (64.6%) during follow-up (median 6.7 months), and the proportion of good outcome increased throughout the study period (r = 0.29, 95% CI 0.05-0.50; p = 0.019). Mild residual symptoms were frequently reported (28.1%) while disabling symptoms were common only in stroke survivors (47.6%). Discussion: Incidence of COVID-associated neurologic disorders decreased during the prevaccination phase of the pandemic. Long-term functional outcome was favorable in most neuro-COVID disorders, although mild symptoms commonly lasted more than 6 months after infection.
Incidence and Long-term Functional Outcome of Neurologic Disorders in Hospitalized Patients With COVID-19 Infected With Pre-Omicron Variants / Beretta, Simone; Cristillo, Viviana; Camera, Giorgia; Morotti Colleoni, Carlo; Pellitteri, Gaia; Viti, Beatrice; Bianchi, Elisa; Gipponi, Stefano; Grimoldi, Maria; Valente, Mariarosaria; Guttmann, Susanna; Cotelli, Maria Sofia; Palumbo, Pasquale; Gelosa, Giorgio; Meletti, Stefano; Schenone, Cristina; Ottaviani, Donatella; Filippi, Massimo; Zini, Andrea; Basilico, Paola; Tancredi, Lucia; Cortelli, Pietro; Braga, Massimiliano; De Giuli, Valeria; Servidei, Serenella; Paolicelli, Damiano; Verde, Federico; Caproni, Stefano; Pisani, Antonio; Lo Re, Vincenzina; Massacesi, Luca; Roccatagliata, Daria Valeria; Manganotti, Paolo; Spitaleri, Daniele; Formenti, Anna; Piccoli, Marta; Marino, Silvia; Polverino, Paola; Aguglia, Umberto; Ornello, Raffaele; Perego, Elisabetta; Siciliano, Gabriele; Merlo, Paola; Capobianco, Marco; Pantoni, Leonardo; Lugaresi, Alessandra; Angelocola, Stefania; De Rosa, Anna; Sessa, Maria; Beghi, Ettore; Agostoni, Elio Clemente; Monaco, Salvatore; Padovani, Alessandro; Priori, Alberto; Silani, Vincenzo; Tedeschi, Gioacchino; Ferrarese, Carlo; Collaborators:; Andrea Pilotto, Stefano Cotti Piccinelli, Susanna Lazzari, Giulia Negro, Giulia Sofia Cereda, Roberto Infante, Ginevra Giovannelli, Claudia Cutellè, Lorenzo Tinti, Susanna Diamanti, Gaia Fanella, Nicola Rifino, Lucio Tremolizzo, Giovanni Ermanis, Fedra Kuris, Roberto Sartor, Francesco Bax, Gian Luigi Gigli, Edoardo Barvas, Mirco Volpini, Roberto Frusciante, Mariaeva Bernardi, Marinella Turla, Raffaella Valenti, Emanuele Bartolini, Lorenzo Kiferle, Silvia Pradella, Alessandro Innocenti, Ludovico Ciolli, Niccolò Orlandi, Gabriele Vandelli, Marco Mazzoli, Luana Benedetti, Matteo Pardini, Stefano Grisanti, Erica Biassoni, Corrado Cabona, Angelo Schenone, Federica Boso, Federica Agosta, Mario Orrico, Luisa Roveri, Giacomo Sferruzza, Mauro Gentile, Laura Piccolo, Elena Merli, Andrea Salmaggi, Tommaso Bocci, Roberta Ferrucci, Michelangelo Dini, Maria Guarino, Marianna Nicodemo, Sandro Beretta, Alessia Giossi, Chiara Campana, Bruno Censori, Guido Primiano, Maria Troiano, Luca Bollo, Narghes Calcagno, Francesca Trogu, Claudia Morelli, Carlo Colosimo, Chiara Di Schino, Franco Costantini, Giuseppe Cosentino, Enrico Marchioni, Federica Avorio, Giovanna Russelli, Giovanna Panarello, Giovanna Carlucci, Federica Azzolini, Antonio Lotti, Alfonso Ciccone, Giovanni Furlanis, Bruno Giometto, Giulia Bellavita, Scarano Valentina, Lorenzo Lorusso, Maria Concetta Altavista, Amelia Brigandì, Chiara Sorbera, Lucia Gatto, Simona Sacco, Raffaella Clerici, Erika Schirinzi, Enrica Bonanni, Elena Merico, Natascia Beretta, Giuseppe Gallo, Chiara Sciolla, Antonio Bertolotto, Simone Pomati, Federico Masserini, Federico Camilli, Ivan Panzera, Patrizio Cardinali, Maria Cristina Acciarri, Giovanna De Michele, Sandra Perillo, Gianluigi Rosalio Palmieri, Nunzia Cuomo, Augusta Giglio. - In: NEUROLOGY. - ISSN 0028-3878. - ELETTRONICO. - 101:(2023), pp. e892-e903. [10.1212/WNL.0000000000207534]
Incidence and Long-term Functional Outcome of Neurologic Disorders in Hospitalized Patients With COVID-19 Infected With Pre-Omicron Variants
Massacesi, Luca;Giovanna Carlucci;Antonio Lotti;
2023
Abstract
Background and objectives: A variety of neurologic disorders have been reported as presentations or complications of coronavirus disease 2019 (COVID-19) infection. The objective of this study was to determine their incidence dynamics and long-term functional outcome. Methods: The Neuro-COVID Italy study was a multicenter, observational, cohort study with ambispective recruitment and prospective follow-up. Consecutive hospitalized patients presenting new neurologic disorders associated with COVID-19 infection (neuro-COVID), independently from respiratory severity, were systematically screened and actively recruited by neurology specialists in 38 centers in Italy and the Republic of San Marino. The primary outcomes were incidence of neuro-COVID cases during the first 70 weeks of the pandemic (March 2020-June 2021) and long-term functional outcome at 6 months, categorized as full recovery, mild symptoms, disabling symptoms, or death. Results: Among 52,759 hospitalized patients with COVID-19, 1,865 patients presenting 2,881 new neurologic disorders associated with COVID-19 infection (neuro-COVID) were recruited. The incidence of neuro-COVID cases significantly declined over time, comparing the first 3 pandemic waves (8.4%, 95% CI 7.9-8.9; 5.0%, 95% CI 4.7-5.3; 3.3%, 95% CI 3.0-3.6, respectively; p = 0.027). The most frequent neurologic disorders were acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), acute ischemic stroke (18.4%), and cognitive impairment (13.7%). The onset of neurologic disorders was more common in the prodromic phase (44.3%) or during the acute respiratory illness (40.9%), except for cognitive impairment whose onset prevailed during recovery (48.4%). A good functional outcome was achieved by most patients with neuro-COVID (64.6%) during follow-up (median 6.7 months), and the proportion of good outcome increased throughout the study period (r = 0.29, 95% CI 0.05-0.50; p = 0.019). Mild residual symptoms were frequently reported (28.1%) while disabling symptoms were common only in stroke survivors (47.6%). Discussion: Incidence of COVID-associated neurologic disorders decreased during the prevaccination phase of the pandemic. Long-term functional outcome was favorable in most neuro-COVID disorders, although mild symptoms commonly lasted more than 6 months after infection.
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