Neuropsychiatric complications of coronavirus disease 2019: Mount Sinai Health System cohort study

Kapil Gururangan; Veronica J Peschansky; Grace Van Hyfte; Parul Agarwal; Leah J Blank; Brian Mathew; Jonathan Goldstein; Churl-Su Kwon; Louise McCarthy; Ariella Cohen; Andy Ho Wing Chan; Pojen Deng; Mandip Dhamoon; Eveline Gutzwiller; Qing Hao; Celestine He; Britany Klenofsky; Hernan Nicolas Lemus; Lara Marcuse; Allison Navis; Wilson D Heredia Nunez; Mallory N Luckey; Emily M Schorr; Anuradha Singh; Gabriela B Tantillo; Claire Ufongene; James J Young; Priti Balchandani; Joanne R Festa; Georges Naasan; Alexander W Charney; Girish N Nadkarni; Nathalie Jetté; Sinai NeuroCOVID-19 Study Group

doi:10.1007/s00415-024-12370-9

Neuropsychiatric complications of coronavirus disease 2019: Mount Sinai Health System cohort study

J Neurol. 2024 Apr 24. doi: 10.1007/s00415-024-12370-9. Online ahead of print.

Authors

Kapil Gururangan^#^{1

2}, Veronica J Peschansky^#^{1

3}, Grace Van Hyfte⁴, Parul Agarwal^{1

4}, Leah J Blank^{1

4}, Brian Mathew¹, Jonathan Goldstein¹, Churl-Su Kwon⁵, Louise McCarthy¹, Ariella Cohen¹, Andy Ho Wing Chan¹, Pojen Deng¹, Mandip Dhamoon¹, Eveline Gutzwiller¹, Qing Hao¹, Celestine He¹, Britany Klenofsky¹, Hernan Nicolas Lemus^{1

6}, Lara Marcuse¹, Allison Navis¹, Wilson D Heredia Nunez¹, Mallory N Luckey¹, Emily M Schorr^{1

7}, Anuradha Singh¹, Gabriela B Tantillo^{1

8}, Claire Ufongene¹, James J Young¹, Priti Balchandani⁹, Joanne R Festa^{1

10}, Georges Naasan^{1

10}, Alexander W Charney^{11

12}, Girish N Nadkarni¹³, Nathalie Jetté^{14

15

16}; Sinai NeuroCOVID-19 Study Group

Affiliations

¹ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
² Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
³ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁴ Department of Population Health Science and Policy, Institute of Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Departments of Neurosurgery, Neurology, Epidemiology, and the Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA.
⁶ Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁷ Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁸ Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
⁹ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁰ The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹² Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹³ Division of Data Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁴ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. nathalie.jette@ahs.ca.
¹⁵ Department of Population Health Science and Policy, Institute of Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA. nathalie.jette@ahs.ca.
¹⁶ Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada. nathalie.jette@ahs.ca.

^# Contributed equally.

PMID: 38656620
DOI: 10.1007/s00415-024-12370-9

Abstract

Objective: To describe the frequency of neuropsychiatric complications among hospitalized patients with coronavirus disease 2019 (COVID-19) and their association with pre-existing comorbidities and clinical outcomes.

Methods: We retrospectively identified all patients hospitalized with COVID-19 within a large multicenter New York City health system between March 15, 2020 and May 17, 2021 and randomly selected a representative cohort for detailed chart review. Clinical data, including the occurrence of neuropsychiatric complications (categorized as either altered mental status [AMS] or other neuropsychiatric complications) and in-hospital mortality, were extracted using an electronic medical record database and individual chart review. Associations between neuropsychiatric complications, comorbidities, laboratory findings, and in-hospital mortality were assessed using multivariate logistic regression.

Results: Our study cohort consisted of 974 patients, the majority were admitted during the first wave of the pandemic. Patients were treated with anticoagulation (88.4%), glucocorticoids (24.8%), and remdesivir (10.5%); 18.6% experienced severe COVID-19 pneumonia (evidenced by ventilator requirement). Neuropsychiatric complications occurred in 58.8% of patients; 39.8% experienced AMS; and 19.0% experienced at least one other complication (seizures in 1.4%, ischemic stroke in 1.6%, hemorrhagic stroke in 1.0%) or symptom (headache in 11.4%, anxiety in 6.8%, ataxia in 6.3%). Higher odds of mortality, which occurred in 22.0%, were associated with AMS, ventilator support, increasing age, and higher serum inflammatory marker levels. Anticoagulant therapy was associated with lower odds of mortality and AMS.

Conclusion: Neuropsychiatric complications of COVID-19, especially AMS, were common, varied, and associated with in-hospital mortality in a diverse multicenter cohort at an epicenter of the COVID-19 pandemic.

Keywords: Coronavirus disease 2019; Mount Sinai Health System; NeuroCOVID; Neurological complications; SARS-CoV-2.