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- Title
Neurological diagnoses in hospitalized COVID-19 patients associated with adverse outcomes: A multinational cohort study.
- Authors
Hutch, Meghan R.; Son, Jiyeon; Le, Trang T.; Hong, Chuan; Wang, Xuan; Shakeri Hossein Abad, Zahra; Morris, Michele; Gutiérrez-Sacristán, Alba; Klann, Jeffrey G.; Spiridou, Anastasia; Batugo, Ashley; Bellazzi, Riccardo; Benoit, Vincent; Bonzel, Clara-Lea; Bryant, William A.; Chiudinelli, Lorenzo; Cho, Kelly; Das, Priyam; González González, Tomás; Hanauer, David A.
- Abstract
Few studies examining the patient outcomes of concurrent neurological manifestations during acute COVID-19 leveraged multinational cohorts of adults and children or distinguished between central and peripheral nervous system (CNS vs. PNS) involvement. Using a federated multinational network in which local clinicians and informatics experts curated the electronic health records data, we evaluated the risk of prolonged hospitalization and mortality in hospitalized COVID-19 patients from 21 healthcare systems across 7 countries. For adults, we used a federated learning approach whereby we ran Cox proportional hazard models locally at each healthcare system and performed a meta-analysis on the aggregated results to estimate the overall risk of adverse outcomes across our geographically diverse populations. For children, we reported descriptive statistics separately due to their low frequency of neurological involvement and poor outcomes. Among the 106,229 hospitalized COVID-19 patients (104,031 patients ≥18 years; 2,198 patients <18 years, January 2020-October 2021), 15,101 (14%) had at least one CNS diagnosis, while 2,788 (3%) had at least one PNS diagnosis. After controlling for demographics and pre-existing conditions, adults with CNS involvement had longer hospital stay (11 versus 6 days) and greater risk of (Hazard Ratio = 1.78) and faster time to death (12 versus 24 days) than patients with no neurological condition (NNC) during acute COVID-19 hospitalization. Adults with PNS involvement also had longer hospital stay but lower risk of mortality than the NNC group. Although children had a low frequency of neurological involvement during COVID-19 hospitalization, a substantially higher proportion of children with CNS involvement died compared to those with NNC (6% vs 1%). Overall, patients with concurrent CNS manifestation during acute COVID-19 hospitalization faced greater risks for adverse clinical outcomes than patients without any neurological diagnosis. Our global informatics framework using a federated approach (versus a centralized data collection approach) has utility for clinical discovery beyond COVID-19. Author summary: Patients hospitalized with acute COVID-19 may concurrently develop central (CNS) or peripheral (PNS) nervous system manifestations that worsen clinical outcomes. Few studies have explicitly distinguished between CNS and PNS involvement when evaluating risks of adverse outcomes. We examined how CNS versus PNS involvement during acute COVID-19 affects patient outcomes by developing a methodological framework to harness the diverse multi-national health records for clinical discovery while preserving patient confidentiality. We applied federated learning methods and rigorous local data quality control to study over 100,000 adults and children hospitalized with acute COVID-19 from 21 healthcare systems spanning 7 countries while ensuring that individual-level patient data remain at the respective healthcare system. We found that adults with CNS or PNS involvement had longer hospitalizations than patients without neurologic involvement. Adults with CNS involvement had an increased risk of death, and the frequency of death was likewise higher in children with CNS involvement. This large study of a geographically diverse cohort of adult and pediatric patients highlights the need for vigilance and prompt treatment of acute COVID-19 patients with CNS involvement. Our global informatics framework using a federated approach (versus a centralized data collection approach) has utility beyond clinical investigation pertaining to COVID-19.
- Subjects
MORTALITY; RISK assessment; PERIPHERAL nervous system; NEUROLOGIC manifestations of general diseases; RESEARCH funding; HOSPITAL care; KRUSKAL-Wallis Test; DESCRIPTIVE statistics; CENTRAL nervous system; LONGITUDINAL method; ANALYSIS of variance; LENGTH of stay in hospitals; CONFIDENCE intervals; COVID-19; PROPORTIONAL hazards models; DISEASE risk factors
- Publication
PLoS Digital Health, 2024, Vol 3, Issue 4, p1
- ISSN
2767-3170
- Publication type
Article
- DOI
10.1371/journal.pdig.0000484