Neuro‐COVID frequency and short‐term outcome in the Northern Portuguese population

Oliveira, Vanessa; Seabra, Mafalda; Rodrigues, Rita; Carvalho, Vanessa; Mendes, Michel; Pereira, Diogo; Caldeiras, Catarina; Martins, Bárbara; Silva, Renata; Azevedo, Ana; Lima, Maria João; Monteiro, Catarina; Varela, Ricardo; Malheiro, Sofia; Abreu, Miguel; Azevedo, Elsa; Leal Loureiro, José; Tedim Cruz, Vítor; Silva, Mário Rui; Magalhães, Rui; Silva, Carolina; Maia, Luís F.; Correia, Manuel

BACKGROUND AND PURPOSE: COVID‐19‐related acute neurological phenotypes are being increasingly recognised, with neurological complications reported in more than 30% of hospitalised patients. However, multicentric studies providing a population‐based perspective are lacking. METHODS: We conducted a retrospective multicentric study at five hospitals in Northern Portugal, representing 45.1% of all hospitalised patients in this region, between 1 March and 30 June 2020. RESULTS: Among 1261 hospitalised COVID‐19 patients, 457 (36.2%) presented neurological manifestations, corresponding to a rate of 357 per 1000 in the North Region. Patients with neurologic manifestations were younger (68.0 vs. 71.2 years, p = 0.002), and the most frequent neurological symptoms were headache (13.4%), delirium (10.1%), and impairment of consciousness (9.7%). Acute well‐defined central nervous system (CNS) involvement was found in 19.1% of patients, corresponding to a rate of 217 per 1000 hospitalised patients in the whole region. Assuming that all patients with severe neurological events were hospitalised, we extrapolated our results to all COVID‐19 patients in the region, estimating that 116 will have a severe neurological event, corresponding to a rate of nine per 1000 (95% CI = 7–11). Overall case fatality in patients presenting neurological manifestations was 19.8%, increasing to 32.6% among those with acute well‐defined CNS involvement. CONCLUSIONS: We characterised the population of hospitalised COVID‐19 patients in Northern Portugal and found that neurological symptoms are common and associated with a high degree of disability at discharge. CNS involvement with criteria for in‐hospital admission was observed in a significant proportion of patients. This knowledge provides the tools for adequate health planning and for improving COVID‐19 multidisciplinary patient care.