Prevention of Neurological Complications During COVID-19: Protocol for a Retrospective Analysis of the ISARIC4C National Cohort

Neurological complications such as stroke and encephalopathies affect 4% of adults with acute COVID-19 infection, causing significant morbidity with long term health and economic consequences. Dexamethasone reduces the 28-day mortality in hospitalised patients requiring supplemental oxygen, while remdesivir has antiviral action against SARS-CoV-2 and reduces the severity of COVID-19 in these patients. We hypothesise that adding either remdesivir, dexamethasone or both to standard of care in patients hospitalised with COVID-19 may reduce the incidence of COVID-19-associated neurological complications. This retrospective analysis of the ISARIC4C cohort will analyse data from patients aged 18 years and older admitted to hospital with COVID-19 between 31 Jan 2020 and 29 Jun 2021. The incidence of neurological complications following COVID-19 in patients receiving standard of care and either remdesivir, dexamethasone or both will be compared against the standard of care using propensity scoring methodology. The effect of neurological complications on markers of disease severity, as well as clinical outcome, will be assessed using multivariable linear and logistic regression.