We aimed to investigate the associations between new-onset neurological symptoms (NNS) and mortality, respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, length of ICU and hospital stay among COVID-19 patients.

We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines.

We included a total of 10,881 patients with confirmed COVID-19 infection (2,008 had NNS; 8,873 did not have NNS). The most common NNS were headache (n = 607, 5.58%), anosmia/hyposmia (n = 544, 5.0%), and altered sensorium (n = 479, 4.4%). The adjusted hazard ratios (aHRs) for mortality among the mild and severe cases were significantly higher by 1.660 (95% CI 1.132–2.435) and by 1.352 (95% CI 1.042–1.752), respectively, in the NNS group compared to those in the non-NNS group. The aHRs for respiratory failure in the NNS group were significantly increased by 1.914 (95% CI 1.346–2.722), by 1.614 (95% CI 1.260–2.068), and by 1.234 (95% CI 1.089–1.398) among the mild, severe, and critical cases, respectively. The aHRs for ICU admission in the NNS group were still significantly higher by 1.973 (95% CI 1.457–2.673) and by 1.831 (95% CI 1.506–2.226) among the mild and severe cases, respectively. Patients who had NNS were not significantly associated with a longer duration of ventilator dependence (adjusted odds ratio (aOR) 0.954, 95% CI 0.772–1.179), longer ICU stay (aOR 0.983, 95% CI 0.772–1.252) and longer hospital admission (aOR 1.045, 95% CI 0.947–1.153).

The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients.