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6-month neurological and psychiatric outcomes in 236379 survivors of COVID-19: a retrospective study using an electronic health record.



Background

Neurological and psychiatric consequences of COVID-19 have been reported, but more information is needed to adequately assess the effects of COVID-19 on brain health. We aim to provide a clear estimate of the incidence and relative risk of neurological and psychiatric diagnoses in patients 6 months after COVID-19 diagnosis.

Method

For this cohort study and time-to-event analysis, we used data obtained from the TriNetX Electronic Health Record Network (more than 81 million patients). It was COVID-19.One matching control group was patients diagnosed with influenza, and the other matched control group was patients diagnosed with respiratory infections, including influenza, during the same period. Patients with a COVID-1

9 diagnosis or a positive test for SARS-CoV-2 were not included in the control group. The entire cohort included patients older than 10 with index symptoms on or after January 20, 2020, and those alive on December 13, 2020.We assessed the incidence of neurological and psychiatric outcomes. 14 items in the 6 months after the confirmed diagnosis of COVID-19: intracranial hemorrhage; Ischemic stroke Parkinsonism; Guillain-Barré syndrome; Nerve dysfunction, nerve root and abdominal separation, myoneural and myalgia; Encephalitis; Dementia; Mental, mood, and anxiety disorders (Grouped and separated); Substance use disorder And insomnia Using the Cox model, we compared incidences with patients with influenza or other respiratory infections.We examined how these estimates were affected by the severity of COVID-19. By hospitalization, intensive therapy (ITU), and cerebrovascular disease (delirium and related disorders), we assessed the strength of outcome differences between cohorts by re-analysis in Various situations To provide a comparison for the incidence and risk of neurological and psychiatric consequences, we compared our main cohort with four patient cohorts diagnosed at the same time as the additional index events: Skin infection, urethritis, large bone fracture, and pulmonary embolism.

Research results

Among 236379 patients diagnosed with COVID-19, the estimated incidence of neurological or psychiatric diagnosis over the next 6 months was 3362% (95% CI 33 17–34 07). Of which 12 84% (12 · 36–13 · 33) were diagnosed for the first time. For patients admitted to ITU, the estimated incidence of diagnosis is 46 42% (44 78–48 09), and for the first diagnosis is 25 79% (23 50–28 25. For the diagnosis of individual studies, the entire COVID-19 group had an incidence of approximately 056% (0 50–0 63) for intracranial hemorrhage, 2 10% (1 97–2 23. ) For ischemia Stroke 0 11% (0 08–0 14) for Parkinson’s disease 0 67% (0 59–0 75) for dementia 17 39% (17 04–17 74 ) For anxiety disorders and 1 40% (1 30–1 51) for psychiatric disorders and others in the ITU treatment group. Estimated incidence was 2 66% (2 24–3. 16) For intracranial hemorrhage, 6 92% (6 17–7 76) for ischemic stroke 0 26% (0 15–0 45) for Parkinson disease 1 74%. (1 · 31–2 · 30) for dementia, 19 · 15% (17 · 90–20 · 48) for anxiety disorders and 2 · 77% (2 · 31–3 · 33) for neuropsychiatric disorders. The most common types of diagnosis are more common in people with COVID-19 than those with the flu. (Hazard ratio [HR] 144, 95% CI 1 40–1 47 for any diagnosis 1 78, 1 68–1 89 for the first diagnosis) and people with other respiratory infections (1 16 , 1 · 14–1 · 17 for any diagnosis, 1 · 32, 1 · 27–136 for the first diagnosis), as well as a higher incidence of HRs in patients with more severe COVID-19. (Eg, ITU admissions versus non: 1 · 58, 1 · 50–1 · 67 for any diagnosis 2 87, 2 45–3 35 for the first diagnosis). Strength of the various sensitivity analyzes and comparison with four additional index health events.

Interpretation

Our study provides evidence for major neurological and psychiatric illness in the six months following COVID-19 infection. The risk was greatest, but not limited to patients with severe COVID-19 infection. In planning service and identifying research priorities Designing complementary studies, including a prospective cohort, is needed to confirm and explain these findings.

Capital

National Institutes of Health Research (NIHR) Oxford Health Biomedical Research Center.


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