Abstract
Several neurological manifestations are part of the post-COVID condition. We aimed to: (1) evaluate the 6-month outcome in the cohort of patients with neurological manifestations during the COVID-19 acute phase and surviving the infection, and find outcome predictors; (2) define the prevalence and type of neurological symptoms persistent at six months after the infection. Data source was an international registry of patients with COVID-19 infection and neurological symptoms, signs or diagnoses established by the European Academy of Neurology. Functional status at six-month follow-up was measured with the modified Rankin scale (mRS), and defined as: “stable/improved” if the mRS at six months was equal as or lower than the baseline score; “worse” if it was higher than the baseline score. By October 30, 2022, 1,003 lab-confirmed COVID-19 patients were followed up for a median of 6.5 months. Compared to their pre-morbid status, 522 patients (52%) were stable/improved, whereas 465 (46%) were worse (functional status missing for 16). Age, hospitalization, several pre-COVID-19 comorbidities, and COVID-19 general complications were predictors of a worse status. Amongst neurological manifestations, stroke carried the highest risk for worse outcome (OR 5.96), followed by hyperactive delirium (2.8), and peripheral neuropathies (2.37). On the other hand, hyposmia/hypogeusia (0.38), headache (0.40), myalgia (0.45), and COVID-19 vaccination (0.52) were predictors of a favourable prognosis. Persisting neurological symptoms or signs were reported by 316/1003 patients (31.5%), the commonest being fatigue (n = 133), and impaired memory or concentration (n = 103). Our study identified significant long-term prognostic predictors in patients with COVID-19 and neurological manifestations.
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Acknowledgements
(§) ENERGY Study Group: Khachik Petrosyan, MD (Department of General and Vascular Neurology, Saint Gregory the Illuminator Medical Center, Yerevan, Armenia), Philipp Kindl, MD (Medical University of Innsbruck; Department of Neurology, Neurocritical Care Unit, Innsbruck, Austria), Ingomar Krehan, MD (Department of Neurology, Kepler University Hospital, Linz, Austria), Johan Sellner, MD (Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria), Edith Kohler, MD (Universitaetsklinikum Tulln, Tulln, Austria), Lucas Scardua, MD PhD (University of Campinas, Campinas, Brazil), Simon Jung, MD and Madlaine Müller, MD (Neurologische Universitätsklinik, Inselspital, Bern, Switzerland), Jitka Bušková, MD PhD (Department of Sleep Medicine, National Institute of Mental Health, Klecany, Czech Republic), Lars Wojtecki, MD (Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist GmbH & Co.KG, Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf, Kempen, Germany), Pille Taba, MD (Head of Institute of Clinical Medicine, University of Tartu, Tartu, Estonia), Sara Meoni, MD (CHU Grenoble Alpes, Grenoble, France), Thomas Michael Jenkins, MBChB (University of Sheffield, Sheffield, United Kingdom), Ivana Vinski, MD (Department of Neurology, UHC Sestre milosrdnice University Hospital Center, Zagreb, Croatia), Dániel Bereczki, MD DSc (Department of Neurology, Semmelweis University, Budapest, Hungary), Netta Agajany, MD ( Tel Aviv University School of Medicine and Shamir (Assaf Harofeh) Medical Center, Tel Aviv, Israel), Marta Bianchi, MD, Patrizia Civelli, MD and Marinella Turla, MD (Neurology Unit ASST Valcamonica-Esine, Brescia, Italy), Franco Valzania, MD, Giulia Toschi, PhD and Jessica Rossi, MD (Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy), Odainic Olesea, MD PhD (Diomid Gherman Institute of Neurology and Neurosurgery), Plesca Svetlana, MD PhD and Manole Elena, MD PhD ( Plesca Svetlana Nicolae Testemisanu State University of Medicine and Pharmacy, Chisinău, Republic of Moldova), Rafael Avalos-Pavon, MD (Neurology Resident, Hospital Central "Dr. Ignacio Moronnes Prieto", Medicine Faculty, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico), Anne Hege Aamodt, MD PhD (Department of Neurology, Oslo University Hospital, Oslo, Norway and Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway), Vojtech Novotny, MD (Haukeland University Hospital, Bergen, Norway), Annette Huuse Farmen, MD (Innlandet Hospital Trust, Brumunddal, Norway), Heidi Øyen Flemmen, PhD MD (Department of Neurology, Telemark Hospital Trust, Skien, Norway), Katarzyna Siutka, MD (Department of Neurology, Specialist Hospital Konskie, Konskie, Poland ), Elaine Santos, MD (Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal), Bárbara Pinto Martins, MD (Neurology Department, Hospital de São João, Porto, Portugal and Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal), Irina Odajiu, MD, Constantin Dragos Sandu, MD, Anca Covaliu, MD, Ana Jugurt, MD (Neurology Department, Colentina Clinical Hospital, Bucharest, Romania), Maria Zakharova, MD PhD (Department of the Research Centre of Neurology, Moscow, Russia), Vasilya Idiiatova, MD (State Nizhnevartovsk City Polyclinic, Nizhnevartovsk, Russia), Serefnur Ozturk, MD (Selcuk University Faculty of Medicine, Department of Neurology, Konya, Turkey).
The authors are indebted to Sherry H-Y Chou MD and Molly McNett PhD for their valuable intellectual support to the organization of the ENERGY registry, to Lalit Kaltenbach for the preparation of the web database, to Ms Anja Sander for her assistance during the activation and conduct of the ENERGY registry, and all participating patients. ENERGY is funded by the European Academy of Neurology.
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Elena Moro reports personal fees from Medtronic, personal fees from Abbott. Maurizio A. Leone, Elisa Bianchi, Raimund Helbock, Clarissa Lin Yasuda, Maria Konti, Dauren Ramankulov, Maria Lolich, Arijana Lovrencic-Huzjan, Tibor Kovács, Carmel Armon, Maria Sofia Cotelli, Francesco Cavallieri, Oxana Grosu, Gordana Kiteva-Trenchevska, Ildefonso Rodriguez-Leyva, Marion Boldingh, Waldemar Brola, Luís F. Maia, Mafalda Maria Laracho de Seabra, Eugenia Irene Davidescu, Bogdan Ovidiu Popescu, Svetlana Kopishinskaia, Claudio Bassetti declare that they have no conflict of interest.
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Leone, M.A., Helbok, R., Bianchi, E. et al. Outcome predictors of post-COVID conditions in the European Academy of Neurology COVID-19 registry. J Neurol (2024). https://doi.org/10.1007/s00415-024-12212-8
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DOI: https://doi.org/10.1007/s00415-024-12212-8