Neurological manifestations as the predictors of severity and mortality in hospitalized individuals with COVID-19: a multicenter prospective clinical study

摘要

The reports of neurological symptoms are increasing in cases with coronavirus disease 2019 (COVID-19). This multi-center prospective study was conducted to determine the incidence of neurological manifestations in hospitalized cases with COVID-19 and assess these symptoms as the predictors of severity and death. Hospitalized males and females with COVID-19 who aged over 18?years were included in the study. They were examined by two neurologists at the time of admission. All survived cases were followed for 8?weeks after discharge and 16?weeks if their symptoms had no improvements. We included 873 participants. Of eligible cases, 122 individuals (13.97%) died during hospitalization. The most common non-neurological manifestations were fever (81.1%), cough (76.1%), fatigue (36.1%), and shortness of breath (27.6%). Aging, male gender, co-morbidity, smoking, hemoptysis, chest tightness, and shortness of breath were associated with increased odds of severe cases and/or mortality. There were 561 (64.3%) cases with smell and taste dysfunctions (hyposmia: 58.6%; anosmia: 41.4%; dysguesia: 100%). They were more common among females (69.7%) and non-smokers (66.7%). Hyposmia/anosmia and dysgeusia were found to be associated with reduced odds of severe cases and mortality. Myalgia (24.8%), headaches (12.6%), and dizziness (11.9%) were other common neurological symptoms. Headaches had negative correlation with severity and death due to COVID-19 but myalgia and dizziness were not associated. The cerebrovascular events (n?=?10) and status epilepticus (n?=?1) were other neurological findings. The partial or full recovery of smell and taste dysfunctions was found in 95.2% after 8?weeks and 97.3% after 16?weeks. The parosmia (30.9%) and phantosmia (9.0%) were also reported during 8?weeks of follow-up. Five cases with mild headaches and 5 cases with myalgia were reported after 16?weeks of discharge. The demyelinating myelitis (n?=?1) and Guillain-Barré syndrome (n?=?1) were also found during follow-up. Neurological symptoms were found to be prevalent among individuals with COVID-19 disease and should not be under-estimated during the current pandemic outbreak.