Neurological diagnoses in hospitalized COVID-19 patients associated with adverse outcomes: A multinational cohort study.

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.
Competing Interests: All authors report no competing interests or conflicts of interest. JGK reports a consulting relationship with the i2b2-tranSMART Foundation through Invocate, Inc. RB reports being a shareholder of Biomeris s.r.l. and Engenome s.r.l. DAH reports entitled to royalties from the University of Michigan for licensing of the EMERSE "synonyms". AM’s work is being funded by the Federal Ministry of Education and Research (BMBF) in Germany in the framework of the MIRACUM Consortium. AM reports being a shareholder of Biomeris s.r.l. BM reports being co-founder and equity owner from DESKI. DLM has received research support from the National Institutes of Health, Department of Veteran Affairs, and the University of Pittsburgh/Pittsburgh Health Data Alliance outside of this work. PA reports consulting for CCHMC and BCH. NG is a co-founder and equity owner of Datavisyn. ZX has served as a Consultant for Genentech/Roche. The institution of ZX has received research support from the National Institute of Health, the National Multiple Sclerosis Society, Food and Drug Administration, the Pittsburgh Foundation, the PNC Charitable Trust, the Ethel Vincent Trust, and Genentech / Roche.
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