April 2021

NEUROSCIENCES

HISTORY OF NEUROLOGICAL DISORDER INCREASES RISK OF HOSPITAL REENCOUNTER AFTER COVID-19

Featuring: Eric Liotta, MD, MS, and Ayush Batra, MD
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A new Northwestern Medicine study published in GeroScience analyzed 509 patients hospitalized for COVID-19 and found that needing to return to the hospital after initial COVID-19 hospitalization is common and that recurrence of COVID-19 symptoms is the leading reason patients seek hospital-level care within 30 days of discharge. The study conducted by the Northwestern Medicine Neuro COVID-19 research group also discovered that patients with a history of neurologic disorders before COVID-19 were at elevated risk to return to the hospital. However, steroid treatment during the initial hospitalization may reduce COVID-19 symptom recurrence that necessitates a return for hospital-level care.

“We were surprised to find that a history of neurologic disorders was the only comorbidity that predicted an increased risk for recurrent medical complications that required hospital-level care, both at 30 days and four months,” says Eric Liotta, MD, a Northwestern Medicine neurocritical care specialist who treats COVID-19 patients at Northwestern Memorial Hospital and co-authored the study. “Neither age, need for mechanical ventilation during COVID-19, nor length of the COVID-19 hospitalization predicted having a hospital reencounter. This finding highlights the unique role of the nervous system in COVID-19 and COVID-19 recovery, a role which has been suggested by other major research groups.”

The 509 patients included in the study were first hospitalized for COVID-19 within the Northwestern Medicine health system between March 5 to April 6, 2020. Of the 509 patients:

• 466 patients (91.6%) were discharged alive from the hospital
-Within 30 days, 12.4% needed hospital-level care
-Within four months, 21.5% of patients needed hospital-level care

• Recurrence of COVID-19 symptoms – including shortness of breath, fatigue, fever and respiratory distress – was the leading reason for hospital-level care, with other leading reasons including:
-Bacterial pneumonia
-Other pulmonary complications
-Infections besides pneumonia
-Bleeding

• Older patients and those with diabetes, chronic obstructive pulmonary disease or organ transplantation had more frequent reencounters

• More than 40% of patients with reencounters had a history of neurological disorders before COVID-19, including epilepsy, stroke, dementia, migraines, spinal stenosis and peripheral neuropathy

The study also found that steroid therapy during the initial hospitalization reduced the need to return to the hospital within 30 days of discharge. Furthermore, patients who continued to test positive for COVID-19 on nasal swabs returned more frequently to the hospital over four months, which supports the idea of a post-viral syndrome in COVID-19.

“Needing to return to the hospital after having been hospitalized for COVID-19 is common,” says Ayush Batra, MD, a Northwestern Medicine neurocritical care specialist who treats COVID-19 patients at Northwestern Memorial Hospital and co-authored the study. “Our future work will seek to identify the full range of symptoms experienced by patients following hospitalization for COVID-19, the duration of those symptoms and their impact on function and quality of life. Additionally, we will assess if specific interventions, such as steroids during COVID-19 hospitalization, demonstrate evidence of mitigating symptoms and improving recovery from COVID-19.”

The Northwestern Medicine Neuro COVID-19 research group also published studies on the neurologic manifestations in patients hospitalized with COVID-19 and the impact on non-hospitalized COVID-19 long-haulers.

To learn more about Northwestern Medicine or the Neuro COVID-19 Clinic, visit nm.org.
Eric Liotta, MD, MS, Assistant Professor of Neurology (Neurocritical Care) and Surgery (Organ Transplantation), and co-author of the study.
Ayush Batra, MD, Assistant Professor of Neurology (Neurocritical Care) and Pathology, and co-author of the study.

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