Risk Factors for New Neurological Diagnoses in Hospitalized COVID-19 Patients: A Case-Control Study in New York City

Background: There have been numerous reports of neurological manifestations identified in hospitalized patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Here, we identify the spectrum of associated neurological symptoms and conditions, define the time course in the development of neurological conditions, address readmission rates and mortality risk post-hospitalization in a multiethnic urban cohort.     Methods: We identify the occurrence of neurological diagnoses among patients with laboratory-confirmed SARS-CoV-2 infection in a multi-ethnic cohort in New York City. We compare demographic and clinical features of COVID-19 patients with neurological diagnoses during hospitalization to those without neurological diagnoses in a retrospective case-control study and examine hospital-related data and outcomes of death and readmission up to 6 months after acute hospitalization in a secondary case-only cohort analysis. A retrospective cohort study was performed of 532 hospitalized patients with neurological manifestations within 6 weeks of positive SARS-CoV-2 laboratory results between March 1, 2020 and August 31, 2020. Findings: The most common neurological diagnoses included encephalopathy (478, 77.3%), stroke (99, 16.0%), and seizures (38, 7.1%).  Those with new neurological diagnoses were more likely than those without neurological diagnoses to be male (312, 58.6%), have baseline neurological comorbidities (193, 36.3%) and be treated in an intensive care unit (ICU) (330, 62.0%) [p for all comparisons < 0.0001]. Of the 394 (74.1%) cases that survived the acute hospitalization, more than half (220/394, 55.8%) were readmitted within 6 months, with a mortality rate of 23.2% during readmission.   Conclusion: Among SARS-CoV-2 infected patients, a significant burden of neurological diagnoses exists, particularly in critically ill populations. Further research is needed to define the impact of neurological diagnoses during acute hospitalization on longitudinal post-coronavirus disease 2019 (COVID-19) related symptoms including neurocognitive impairment.Funding Information: Supported by the Centers for Disease Control and Prevention (contract 75D30120C07986 to Westat), F30 MH114390 to OJL.Declaration of Interests: MSVE: Dr. Elkind receives royalties from UpToDate for a chapter on COVID-19 and neurological disease. Dr. Sobieszczyk was funded by a COVID supplement to the National Institute Of Allergy And Infectious Diseases of the National Institutes of Health under Award Number UM1AI06947. No other interests to declare.Ethics Approval Statement: This study received approval from CUIMC institutional review board (IRB) with a waiver of written informed consent for retrospective analysis.