Neurological symptoms and comorbidity profile of hospitalized patients with COVID-19

Cremaschi, Renata Carvalho; Bahi, Carla Alessandra Scorza; Paola, Angelo Amato Vincenzo de; Arakaki, Jaquelina Sonoe Ota; Ferreira, Paulo Roberto Abrão; Bellei, Nancy Cristina Junqueira; Borges, Vanderci; Coelho, Fernando Morgadinho Santos

doi:10.1055/s-0043-1761433

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Original Article • Arq. Neuropsiquiatr. 81 (2) • 2023 • https://doi.org/10.1055/s-0043-1761433 copy

Neurological symptoms and comorbidity profile of hospitalized patients with COVID-19

Sintomas neurológicos e perfil de comorbidades de pacientes hospitalizados com COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

The neurological manifestations in COVID-19 adversely impact acute illness and post-disease quality of life. Limited data exist regarding the association of neurological symptoms and comorbid individuals.

Objective

To assess neurological symptoms in hospitalized patients with acute COVID-19 and multicomorbidities.

Methods

Between June 2020 and July 2020, inpatients aged 18 or older, with laboratory-confirmed COVID-19, admitted to the Hospital São Paulo (Federal University of São Paulo), a tertiary referral center for high complexity cases, were questioned about neurological symptoms. The Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire was used. The data were analyzed as a whole and whether subjective olfactory dysfunction was present or not.

Results

The mean age of the sample was 55 ± 15.12 years, and 58 patients were male. The neurological symptoms were mostly xerostomia (71%), ageusia/hypogeusia (50%), orthostatic intolerance (49%), anosmia/hyposmia (44%), myalgia (31%), dizziness (24%), xerophthalmia (20%), impaired consciousness (18%), and headache (16%). Furthermore, 91% of the patients had a premorbidity. The 44 patients with subjective olfactory dysfunction were more likely to have hypertension, diabetes, weakness, shortness of breath, ageusia/hypogeusia, dizziness, orthostatic intolerance, and xerophthalmia. The COMPASS-31 score was higher than that of previously published controls (14.85 ± 12.06 vs. 8.9 ± 8.7). The frequency of orthostatic intolerance was 49% in sample and 63.6% in those with subjective olfactory dysfunction (2.9-fold higher risk compared to those without).

Conclusion

A total of 80% of inpatients with multimorbidity and acute COVID-19 had neurological symptoms. Chemical sense and autonomic symptoms stood out. Orthostatic intolerance occurred in around two-thirds of the patients with anosmia/hyposmia. Hypertension and diabetes were common, mainly in those with anosmia/hyposmia.

Keywords:
COVID-19; Neurologic Manifestations; Comorbidity; Anosmia; Orthostatic Intolerance; Autonomic Nervous System Diseases

		Overall	OD		p-value
		Overall	without	with	p-value
		(N = 100)	(N = 56)	(N = 44)
Age, years		55.02 ± 15.12	55.16 ± 15.26	54.84 ± 15.11	0.91
Age category, %	18–60 years	61	57.1	65.9	0.37
Age category, %	>60 years	39	42.9	34.1	0.37
Male gender, %		58	66.1	47.7	0.06
BMI, kg/m²		27.66 ± 5.96	27.49 ± 5.38	27.79 ± 6.42	0.80
Regular medications use	Antihypertensives¹	66	67.9	63.6	0.65
	Antidepressants and neuroleptics	6	3.6	9.1	0.40
	Immunosuppressants	31	30.4	31.8	0.87
	Oral corticosteroids	27	26.8	27.3	0.95
	Oral anticoagulants	4	3.6	4.5	1
General symptoms, %	Anorexia	50	42.9	59.1	0.10
	Fever/chill	66	66.1	65.9	0.98
	Weakness	60	50.0	72.7	0.02
	Cough	68	62.5	75.0	0.18
	Sore throat	25	19.6	31.8	0.16
	Rhinorrhea	21	23.2	18.2	0.54
	Shortness of breath	66	57.1	77.3	0.03
	Diarrhea	50	50	50	1
	Nausea/vomiting	35	35.7	34.1	0.86
	Constipation	15	7.1	25	0.01
Viral load quantitation, %	High	44	40.0	59.5	0.07
	Low	45	60.0	40.5
	Missing²	13	6	7
Delay to confirmation, days³		6.08 ± 4.24	6.25 ± 4.49	5.86 ± 3.93	0.65
White blood cells⁴	Leucocyte count	9,164 ± 6,581	8,636 ± 6,831	9,835 ± 6,262	0.36
	Neutrophils count	6,859 ± 4,815	6,638 ± 5,286	7,140 ± 4,182	0.60
	Lymphocytes count	1,202 ± 876	1,011 ± 724	1,445 ± 995	0.01
Platelet	Count⁴ *1000	214.85 ± 95.71	198.84 ± 92.86	235.23 ± 96.45	0.05
Platelet	Thrombocytopenia, % (<100,000⁴)	27	35.7	15.9	0.02
Serum creatinine⁵		2.82 ± 7.07	2.28 ± 3.04	3.51 ± 10.12	0.39
Blood urea nitrogen⁵		63.47 ± 53.59	66.29 ± 61.09	59.95 ± 42.85	0.56
C-reactive protein⁶		104.23 ± 79.82	104.96 ± 78.76	103.3 ± 82.07	0.91
Lactose dehydrogenase⁷		384.12 ± 164.71	351.3 ± 140.63	420.23 ± 182.7	0.05
Chest CT category, %⁸	0 (none)	7	5.4	9.1	0.001
	1 (<25%)	43	60.7	20.5*
	2 (25–49%)	31	21.4	43.2*
	3 (50–75%)	18	12.5	25.7
	4 (>75%)	1	0.0	2.3

		OD
	Overall	without	with	p-value
	(N = 100)	(N = 56)	(N = 44)
Delay, days¹	1.48 ± 3.41	1.39 ± 3.48	1.55 ± 3.39	0.84
Neurological symptom, %	80	64.3	100	<0.001
Ageusia/hypogeusia²	50	12.5	97.7	<0.001
Vision impairment	11	8.9	13.6	0.45
Dizziness³	24	16.1	34.1	0.03
Irritability	12	7.1	18.2	0.09
Impaired consciousness⁴	18	23.2	11.4	0.12
Confusion	9	8.9	9.1	0.97
Muscle weakness⁵	2	1.8	2.3	1
Myalgia	31	23.2	40.9	0.05
Headache	16	12.5	20.5	0.28
Orthostatic intolerance⁶	49	37.5	63.6	0.01
Frequency
Never	51	62.5	36.4*	0.02
Rarely	14	12.5	15.9
Occasionally	19	17.9	20.5
Frequently	15	7.1	25*
Almost always	1	0	2.3
Intensity				0.01
None	51	62.5*	36.4*
Mild	23	23.2	22.7
Moderate	20	12.5	29.5*
Severe	6	1.8*	11.4*	0.03
Xerophthalmia⁷	20	12.5	29.5	0.03
Xerostomia	71	64.3	79.5	0.09
COMPASS-31 TWS (0–100)	16.69 ± 11.52	12.92 ± 13.72	20.90 ± 23.47	0.002
TWS minus GI (0–75)	13.82 ± 9.71	10.58 ± 12.16	17.21 ± 20.26	0.003

		OD
	Overall	without	with	p-value
	(N = 100)	(N = 56)	(N = 44)
Associated medical disease, %
Hypertension	60	50	72.7	0.02
Diabetes mellitus	40	25	59.1	0.001
Obesity (BMI >30 kg/m²)	33	32.1	34.1	0.83
Smoking history¹	25	26.8	22.7	0.64
Cardiac diseases²	23	25	20.5	0.59
Chronic pulmonary disease³	10	12.5	6.8	0.34
End-stage renal disease	31	30.4	31.8	0.87
Kidney transplantation	24	23.2	25	0.83
Hemodialysis	7	7.1	6.8	1
Malignancy	9	8.9	9.1	0.97
Asthma	7	3.6	11.4	0.23
Vasculiti⁴	7	8.9	4.5	0.46
Cerebrovascular	7	3.6	11.4	0.23
Peripheral artery and aneurysm	2	0	4.5	0.37
Falciform anemia	2	1.8	2.3	1
Pulmonary tuberculosis	1	1.8	0	1
Other⁵	24	30.4	15.9	0.09
Charlson Comorbidity Index grade, %				0.64
None (CCI = 0)	9	10.7	6.8	0.49
Mild (CCI = 1–2)	26	26.8	25	0.84
Moderate (CCI = 3–4)	39	41.1	36.4	0.63
Severe (CCI ≥ 5)	26	21.4	31.8	0.24

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[1] Address for correspondence Fernando Morgadinho Santos Coelho (email: fernandomorgadinho@hotmail.com).