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The 6-month neurological and psychiatric prognosis of 236 379 COVID-19 survivors: a retrospective cohort study using electronic health records



background

The neurological and psychiatric sequelae of COVID-19 have been reported, but more data are needed to fully assess the impact of COVID-19 on brain health. We aim to provide reliable estimates of the incidence and relative risk of neurological and psychiatric diagnoses in patients within 6 months of COVID-19 diagnosis.

method

For this retrospective cohort study and time-to-event analysis, we used data obtained from the TriNetX electronic health record network (with 81 million patients). Our main cohort includes patients diagnosed with COVID-19; a matched control cohort includes patients diagnosed with influenza, and another matched control cohort includes patients diagnosed with any respiratory infections including influenza during the same period. Patients diagnosed as positive for COVID-1

9 or SARS-CoV-2 were excluded from the control cohort. All cohorts included patients over the age of 10 who had an index event on or after January 20, 2020, and were still alive on December 13, 2020. We estimate that there are 14 cases of COVID-19 with neurological and psychiatric prognosis within 6 months after diagnosis: intracranial hemorrhage; ischemic stroke; Parkinson’s disease; Guillain-Barré syndrome; nerve, nerve root and plexus disease; Muscular junctions and muscle diseases; encephalitis; dementia; psychosis, mood and anxiety disorders (groups and separate groups); substance use disorders; and insomnia. Using the Cox model, we compared the incidence with the incidence in a cohort of patients with influenza or other respiratory infections that were matched with propensity scores. We investigated how these estimates are affected by the severity of COVID-19, such as hospitalizations, intensive treatment unit (ITU) admissions, and encephalopathy (irritation and related diseases) proxies. By repeating the analysis in different situations, we assessed the robustness of the difference in results between the cohorts. In order to provide a baseline for the incidence and risk of neurological and psychiatric sequelae, we compared our main cohort with four groups of patients diagnosed in the same period with other index events: skin infections, urinary tract stones, large bone fractures, and lungs. embolism.

Find

Among the 236379 patients diagnosed with COVID-19, the estimated incidence of neurological or psychiatric diagnosis in the next 6 months was 33.62% (95% CI 33.17–34.07), of which 12.84% (12·36–13·33) For the first time received such a diagnosis. For patients who have been admitted to the ITU, the estimated incidence of diagnosis is 46.42% (44.78–48.09), and the first diagnosis is 25.79% (23.50–28.25). Regarding the individual diagnosis of the study results, the incidence of intracranial hemorrhage in the entire COVID-19 cohort is estimated to be 0.56% (0.50-0.63), and the incidence of ischemia is 2.10% (1.97-2.23) Stroke, Parkinson’s disease is 0.11% (0·08–0·14), dementia is 0.67% (0·59–0.75), and anxiety is 17.39% (17·04–17· 74), of which 1% are mentally ill, accounting for 40% (1.30-1.51). Among the population receiving ITU, the estimated incidence of intracranial hemorrhage was 2.66% (2.24–3.16), and the incidence of ischemic stroke was 6.92% (6.17–7.76). 0.26% (0 Parkinson’s disease 15–0.45), dementia 1.74% (1.31–2.30), anxiety 19.15% (17.90–20.48) and 2.77% (2.31–3.33) are used for mental illness.Most diagnostic categories are more common in COVID-19 patients than in influenza patients (hazard ratio [HR] 1.44, 95% CI 1.40-1.47, used for any diagnosis; the first diagnosis was 1.78, 1.68-1.89) and patients with other respiratory infections (diagnosed 1.16, 1.14-1.17; 1.32, 1.27– 1.36 (for any first diagnosis). As with the incidence, patients with severe COVID-19 (for example, patients admitted to the ITU) are not Compared with patients in the following situations, HRs are higher: 1.58, 1.50-1.67, for any diagnosis; 2.87, 2.45–3.35, for any first diagnosis). The results are very reliable for various sensitivity analyses and benchmark tests for the other four index health events.

Explanation

Our research provides evidence of a large number of neurological and psychiatric morbidities within 6 months of COVID-19 infection. Among patients with severe COVID-19, the risk is greatest, but it is not limited to this. This information can help with service planning and research priorities. Additional study designs, including prospective cohort studies, are needed to confirm and explain these findings.

funds

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


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