Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy

Alberto Benussi; Andrea Pilotto; Enrico Premi; Ilenia Libri; Marcello Giunta; Chiara Agosti; Antonella Alberici; Enrico Baldelli; Matteo Benini; Sonia Bonacina; Laura Brambilla; Salvatore Caratozzolo; Matteo Cortinovis; Angelo Costa; Stefano Cotti Piccinelli; Elisabetta Cottini; Viviana Cristillo; Ilenia Delrio; Massimiliano Filosto; Massimo Gamba; Stefano Gazzina; Nicola Gilberti; Stefano Gipponi; Alberto Imarisio; Paolo Invernizzi; Ugo Leggio; Matilde Leonardi; Paolo Liberini; Martina Locatelli; Stefano Masciocchi; Loris Poli; Renata Rao; Barbara Risi; Luca Rozzini; Andrea Scalvini; Francesca Schiano di Cola; Raffaella Spezi; Veronica Vergani; Irene Volonghi; Nicola Zoppi; Barbara Borroni; Mauro Magoni; Alessandro Pezzini; Alessandro Padovani

doi:10.1212/WNL.0000000000009848

Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy

Neurology. 2020 Aug 18;95(7):e910-e920. doi: 10.1212/WNL.0000000000009848. Epub 2020 May 22.

Authors

Alberto Benussi¹, Andrea Pilotto¹, Enrico Premi¹, Ilenia Libri¹, Marcello Giunta¹, Chiara Agosti¹, Antonella Alberici¹, Enrico Baldelli¹, Matteo Benini¹, Sonia Bonacina¹, Laura Brambilla¹, Salvatore Caratozzolo¹, Matteo Cortinovis¹, Angelo Costa¹, Stefano Cotti Piccinelli¹, Elisabetta Cottini¹, Viviana Cristillo¹, Ilenia Delrio¹, Massimiliano Filosto¹, Massimo Gamba¹, Stefano Gazzina¹, Nicola Gilberti¹, Stefano Gipponi¹, Alberto Imarisio¹, Paolo Invernizzi¹, Ugo Leggio¹, Matilde Leonardi¹, Paolo Liberini¹, Martina Locatelli¹, Stefano Masciocchi¹, Loris Poli¹, Renata Rao¹, Barbara Risi¹, Luca Rozzini¹, Andrea Scalvini¹, Francesca Schiano di Cola¹, Raffaella Spezi¹, Veronica Vergani¹, Irene Volonghi¹, Nicola Zoppi¹, Barbara Borroni¹, Mauro Magoni¹, Alessandro Pezzini¹, Alessandro Padovani²

Affiliations

¹ From the Neurology Unit (A.B., A. Pilotto, I.L., M.G., E.B., S.B., M.C., S.C.P., V.C., A.I., M. Locatelli, S.M., B.R., L.R., A.S., F.S.d.C., N.Z., B.B., A. Pezzini, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia; Neurology Unit (A.B., A. Pilotto, C.A., A.A., S.C., E.C., M.F., S. Gipponi, P.L., L.P., R.R., L.R., I.V., B.B., A. Pezzini, A. Padovani), Vascular Neurology Unit (E.P., A.C., I.D., M.G., N.G., R.S., V.V., M.M.), and Neurophysiology Unit (S. Gazzina, U.L.), Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia; Neurology Unit (M.B.), University of Bologna; Department of Neuroimmunology and Neuromuscular Diseases (L.B.) and Neurology (M. Leonardi), Public Health and Disability Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan; and Neurology Unit (P.I.), Fondazione Poliambulanza Hospital, Brescia, Italy.
² From the Neurology Unit (A.B., A. Pilotto, I.L., M.G., E.B., S.B., M.C., S.C.P., V.C., A.I., M. Locatelli, S.M., B.R., L.R., A.S., F.S.d.C., N.Z., B.B., A. Pezzini, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia; Neurology Unit (A.B., A. Pilotto, C.A., A.A., S.C., E.C., M.F., S. Gipponi, P.L., L.P., R.R., L.R., I.V., B.B., A. Pezzini, A. Padovani), Vascular Neurology Unit (E.P., A.C., I.D., M.G., N.G., R.S., V.V., M.M.), and Neurophysiology Unit (S. Gazzina, U.L.), Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia; Neurology Unit (M.B.), University of Bologna; Department of Neuroimmunology and Neuromuscular Diseases (L.B.) and Neurology (M. Leonardi), Public Health and Disability Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan; and Neurology Unit (P.I.), Fondazione Poliambulanza Hospital, Brescia, Italy. alessandro.padovani@unibs.it.

PMID: 32444493
DOI: 10.1212/WNL.0000000000009848

Abstract

Objective: To report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19).

Methods: In this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period.

Results: One hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0-83.8 years vs 70.1 years, IQR 52.9-78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7-1.1 vs 0.5, IQR 0.4-0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21-16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97-0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00-1.03, p = 0.009) on admission.

Conclusions: Patients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.

MeSH terms

Aged
Aged, 80 and over
Betacoronavirus / isolation & purification
COVID-19
Case-Control Studies
Comorbidity
Coronavirus Infections / diagnosis
Coronavirus Infections / epidemiology*
Coronavirus Infections / mortality
Female
Hospital Mortality
Humans
Inpatients / statistics & numerical data*
Italy / epidemiology
Male
Middle Aged
Nervous System Diseases / diagnosis
Nervous System Diseases / epidemiology*
Nervous System Diseases / mortality
Pandemics
Pneumonia, Viral / diagnosis
Pneumonia, Viral / epidemiology*
Pneumonia, Viral / mortality
Retrospective Studies
SARS-CoV-2
Severity of Illness Index