Determine outcomes of hospitalized adult patients with severe acute respiratory syndrome coronavirus disease-2019 (COVID-19) and neurological dysfunction.

Emerging data suggest a wide range of neurological symptoms associated with COVID-19.  Outcomes of patients with neurological dysfunctions and COVID-19 is unknown.

A prospective cohort of 127 consecutive adult (age>18) patients admitted with suspected or confirmed COVID-19 infection to single academic hospital from 30/22/2020-09/05/2020 were included. We are part of the GCS-NeuroCOVID consortium.  Eight patients met exclusion criteria of severe pre-existing baseline neurologic dysfunction that limit detection of new or worsening symptoms. Neurological dysfunctions were systematically recorded.  Global outcome is measured by modified Rankin Score (mRS) at hospital discharge.  Between-group differences were compared using parametric or non-parametric test based on data distribution.

The final cohort consisted of 119 COVID-19 subjects where 73 (61%) had new neurological dysfunction. Patients with neurological dysfunctions had similar mean age (63.4 vs. 59.3 years) and gender distribution (52% vs. 50% male) compared to those without neurological dysfunction.  Presence of neurological dysfunction is associated with need for mechanical ventilation (39.7% vs. 10.9%, p=.0007), longer median ICU (4 vs. 0 days, p=.0004) and hospital lengths of stay (12.5 vs. 6 days, p=.0007), worse functional outcome at discharge (mRS 3 vs. 1, p=.002) and non-home discharge destination (43% vs. 70%, p=.002).  Neurological symptoms may be associated with higher incidence of do-not-resuscitate code status (27% vs. 13%, p=0.058) but did not impact in-hospital mortality (17.8% vs. 8.7%, p=0.19). 

COVID-19 patients with new or worsened neurological dysfunction are more likely to require mechanical ventilation, had longer ICU and hospital length of stay, and worse global functional outcome at discharge. Relatively low mortality rate makes this study under-powered to detect a between-group mortality difference.  Future studies are needed to determine long-term outcome impacts of neurological dysfunction associated with COVID-19.