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

for the Sinai NeuroCOVID-19 Study Group

doi:10.1007/s00415-024-12370-9

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

for the Sinai NeuroCOVID-19 Study Group

Neurology

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Pages (from-to)	3991-4007
Number of pages	17
Journal	Journal of Neurology
Volume	271
Issue number	7
DOIs	https://doi.org/10.1007/s00415-024-12370-9
State	Published - Jul 2024

Funding

KG serves as a clinical and scientific advisor to Ceribell Inc., receives consulting fees for research contributions unrelated to this work, and owns stock options in Ceribell Inc.; he received grant funding paid to his institution from NINDS (NIH R25NS079102) and the Leon Levy Foundation; and he serves as a review editor for Frontiers in Neurology-Epilepsy. VJP received grant funding paid to her institution from NINDS (NIH R25NS079102) and the Leon Levy Foundation. PA received grant funding paid to her institution from NICHD (NIH R01HD100544), NIH (PD22-01299) and SU2C 6209, and she receives an honorarium for her work as an assistant editor of Statistics of Anesthesia & Analgesia. LJB received research support from the American Epilepsy Society, Epilepsy Foundation, NORSE Institute, NIA (NIH T32AG066598), Mount Sinai Claude D. Pepper Older American Independence Center (5P30AG028741-11), and Icahn School of Medicine Department of Neurology. CSK received research support from the American Epilepsy Society as well as grant funding paid to his institution from the Leon Levy Foundation. EMS received fellowship funding paid to her institution from Biogen. CU was funded by the Medical Student Training in Aging Research program sponsored by the National Institute of Aging. JJY received research support from Monteris for unrelated work and grant funding paid to his institution from NINDS (R25NS8440304) and the Leon Levy Foundation. PB received grant funding paid to her institution from NCI (NIH R01CA202911), NIMH (NIH R01MH116953), NIA (NIH R21AG076211), NIDCR (NIH R56DE030680), and NINDS (NIH R00NS070821, NIH R21NS122389). GN received an honorarium for advisory work from Genentech. AWC received grant funding paid to his institution from NIMH (NIH U01MH109536, NIH R01MH121923, NIH R01MH130662) and NIA (NIH R01AG069976). GNN received grant funding paid to his institution from NIDDK (NIH K23DK107908, NIH R01DK127139, NIH U01DK133093) and NHLBI (NIH R01HL155915). NJ received grant funding paid to her institution from NINDS (NIH U24NS107201, NIH U54NS100064, NIH U24NS113849), the American Epilepsy Society, and the NORSE Institute during the study period; she receives an honorarium for her work as an associate editor of Epilepsia, and she was the Icahn School of Medicine Bludhorn Professor of International Medicine. The remaining authors report no conflicts of interest or disclosures.

Keywords

Coronavirus disease 2019
Mount Sinai Health System
NeuroCOVID
Neurological complications
SARS-CoV-2

ASJC Scopus subject areas

Neurology
Clinical Neurology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s00415-024-12370-9

Cite this

@article{9718f7b4fb2d487ba8751043ee68e944,

title = "Neuropsychiatric complications of coronavirus disease 2019: Mount Sinai Health System cohort study",

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",

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

note = "Publisher Copyright: {\textcopyright} Springer-Verlag GmbH Germany, part of Springer Nature 2024.",

year = "2024",

month = jul,

doi = "10.1007/s00415-024-12370-9",

language = "English (US)",

volume = "271",

pages = "3991--4007",

journal = "Journal of Neurology",

issn = "0340-5354",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "7",

}

TY - JOUR

T1 - Neuropsychiatric complications of coronavirus disease 2019

T2 - Mount Sinai Health System cohort study

AU - for the Sinai NeuroCOVID-19 Study Group

AU - Gururangan, Kapil

AU - Peschansky, Veronica J.

AU - Van Hyfte, Grace

AU - Agarwal, Parul

AU - Blank, Leah J.

AU - Mathew, Brian

AU - Goldstein, Jonathan

AU - Kwon, Churl Su

AU - McCarthy, Louise

AU - Cohen, Ariella

AU - Chan, Andy Ho Wing

AU - Deng, Pojen

AU - Dhamoon, Mandip

AU - Gutzwiller, Eveline

AU - Hao, Qing

AU - He, Celestine

AU - Klenofsky, Britany

AU - Lemus, Hernan Nicolas

AU - Marcuse, Lara

AU - Navis, Allison

AU - Heredia Nunez, Wilson D.

AU - Luckey, Mallory N.

AU - Schorr, Emily M.

AU - Singh, Anuradha

AU - Tantillo, Gabriela B.

AU - Ufongene, Claire

AU - Young, James J.

AU - Balchandani, Priti

AU - Festa, Joanne R.

AU - Naasan, Georges

AU - Charney, Alexander W.

AU - Nadkarni, Girish N.

AU - Jetté, Nathalie

PY - 2024/7

Y1 - 2024/7

N2 - 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.

AB - 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.

KW - Coronavirus disease 2019

KW - Mount Sinai Health System

KW - NeuroCOVID

KW - Neurological complications

KW - SARS-CoV-2

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UR - http://www.scopus.com/inward/citedby.url?scp=85191187870&partnerID=8YFLogxK

U2 - 10.1007/s00415-024-12370-9

DO - 10.1007/s00415-024-12370-9

M3 - Article

C2 - 38656620

AN - SCOPUS:85191187870

SN - 0340-5354

VL - 271

SP - 3991

EP - 4007

JO - Journal of Neurology

JF - Journal of Neurology

IS - 7

ER -

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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