In a recent study published in Nature Medicine, researchers assessed long-term neurological sequelae in the post-acute phase of coronavirus disease 2019 (COVID-19), or long-term COVID-19.
Study: Long-term neurological outcomes of COVID-19. Image credit: Starocean/Shutterstock
Long-term COVID refers to the spectrum of post-acute sequelae of COVID-19 involving various extrapulmonary manifestations, including neurological abnormalities. Most studies investigating long-term neurological disorders associated with COVID have been restricted to patients hospitalized during acute SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infections, followed for <6 months for a small range of neurological outcomes .
A comprehensive assessment of long-term neurologic outcomes of COVID-19 is required after one year of acute COVID-19, assessing neurologic outcomes in different care settings in the acute phase of COVID-19, including those who were not hospitalized, hospitalized and intensive care units (ICU). -admitted).
About the study
In the present study, the researchers evaluated neurological sequelae among long-term patients with COVID.
Data were obtained from the US Department of Veterans Affairs (US) national healthcare databases for 154,068 individuals who lived beyond the initial month of SARS-CoV-2 infections and two groups of control individuals: the contemporary control group consisting of 5,638,795 US VHA (veterans). ‘of the Department of Health System) users without exposure to SARS-CoV-2 and the historical control group consisting of 5,859,621 US VHA users who predated the SARS-CoV-2 pandemic (2017).
Inverse probability weighting was used to balance the contemporaneous COVID-19 and control groups, hazard ratios (HRs) were calculated, and burdens and risks of prespecified neurological disorders were estimated after one year of Acute COVID-19. In addition, the team assessed incident neurologic disorders among the SARS-CoV-2 infection group based on acute care settings for COVID-19 (hospitalized, hospitalized, and ICU admissions including 131,915, 16,764 and 5,389 patients, respectively).
In addition, two sensitivity analyzes were performed; one involved only prespecified covariates, and the other involved applying covariate adjustments and weighting. To verify the reproducibility of the study approach, we assessed fatigue as a positive outcome control and receipt of influenza vaccinations between March 1, 2020 and January 15, 2021, in days natural even and odd between 571,291 and 605,453 individuals, respectively, according to negative exposure controls.
results
People who lived beyond the initial month of SARS-CoV-2 infections showed an elevated risk of developing cerebral venous thrombosis (CVT, HR 2.7; burden 0.1), hemorrhagic stroke (HR 2.2 ; load 0.2) and ischemic stroke. [HR 1.5; burden 3.4 for every 1,000 individuals at one-year, transient ischemic attacks (HR 1.6; burden 2.0)]. The burden and risk of the composite cerebrovascular outcome were 4.9 and 1.6, respectively.
Elevated risks for Alzheimer’s disease (AD, HR 2.0, loading 1.7) and memory problems (HR 1.8; loading 10) were observed with loading and composite risk of memory and cognition outcomes of 10 and 1.8, respectively. The risks and burdens of peripheral neuropathic disease (HR 1.3, burden 5.6), paraesthesia (HR 1.3, burden 2.9), Bell’s palsy (HR 1.5, burden 0.3 ) and dysautonomia (HR 1.3, burden 1.6) with the peripheral outcome composite burden and risk being 8.6 and 1.3, respectively.
Outcomes for episodic disorders included seizures and epilepsy (HR 1.8; burden 2.0), headache-related illnesses (HR 1.4, burden 1.5) and migraine (HR 1.2, burden 2.0 ), with the composite burden and risk for the episodic disorder outcome of 4.8. and 1.3, respectively. Movement and extrapyramidal disorders included involuntary movement abnormalities (HR 1.4, loading 2.9), tremors (HR 1.4, loading 1.1), Parkinson-like disease (HR 1.5, loading 0.9 ), myoclonus (HR 1.4, load 0.1) and dystonia (HR). 1.6, burden 0.4) with the composite burden and risk for movement outcome and extrapyramidal disorder of 4.0 and 1.4, respectively.
Mental health illnesses included major depressive illness (HR 1.4, loading 17), adjustment and stress disorders (HR 1.4, loading 14.3), anxiety (HR 1.4, loading 12.4), and psychotic illness (HR 1.5, loading 1.0). The composite burden and risk of mental health problems were 25 and 1.4, respectively. Musculoskeletal diseases included arthralgia (HR 1.3, loading 28), myopathic disease (HR 2.8, loading 0.7) and myalgia (HR 1.8, loading 16), with the composite burden and risk of musculoskeletal disorder outcome of 40 and 1.5, respectively.
Sensory disorder outcomes included tinnitus or auditory abnormalities (HR 1.2, burden 11.9), visual dysfunction (HR 1.3, burden 5.6), loss of smell (HR 4.1, burden 1.1) and loss of taste (HR 2.3, burden 0.1), with the compound load. and the risk for the sensory disorder outcome is 17 and 1.3, respectively. Other neurological or associated disorder outcomes included somnolence (HR 1.7, loading 0.6), dizziness (HR 1.4, loading 6.7), Guillain-Barré syndrome (HR 2.2, loading 0.1 ), transverse myelitis (HR 1.5, loading 0.03) or encephalopathy. encephalitis (HR 1.8, burden 0.1) and the composite burden and risk for the other neurologic or associated disorder outcome were 7.4 and 1.5, respectively.
The overall burden and risk of any prespecified neurologic sequelae were estimated to be 71 and 1.4 per 1,000 persons at one year after acute COVID-19, respectively, compared with contemporary controls. Risks and burdens among patients with COVID-19 (compared with contemporaneous controls) were elevated even among patients who did not require hospital admission in acute COVID-19, according to severity of COVID-19.
The risks of developing episodic disorders, mental health disorders, musculoskeletal disorders, and any neurological disorder increased with age. In contrast, those of cognitive and memory disorders, sensory disorders, and other neurological or associated disorders decreased with age. Similar findings were obtained in sensitivity analyses, and COVID-19 was associated with elevated risks of fatigue compared with contemporary controls, but had no significant association with influenza vaccinations.
Overall, the study’s findings highlighted the long-term neurological sequelae of COVID-19, which would help guide policymaking and health care planning for long-term care of the COVID patient.