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Neuropsychiatric complications of coronavirus disease 2019: Mount Sinai Health System cohort study

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Abstract

Objective

To describe the frequency of neuropsychiatric complications among hospitalized patients with coronavirus disease 2019 (COVID-19) and their association with pre-existing comorbidities and clinical outcomes.

Methods

We retrospectively identified all patients hospitalized with COVID-19 within a large multicenter New York City health system between March 15, 2020 and May 17, 2021 and randomly selected a representative cohort for detailed chart review. Clinical data, including the occurrence of neuropsychiatric complications (categorized as either altered mental status [AMS] or other neuropsychiatric complications) and in-hospital mortality, were extracted using an electronic medical record database and individual chart review. Associations between neuropsychiatric complications, comorbidities, laboratory findings, and in-hospital mortality were assessed using multivariate logistic regression.

Results

Our study cohort consisted of 974 patients, the majority were admitted during the first wave of the pandemic. Patients were treated with anticoagulation (88.4%), glucocorticoids (24.8%), and remdesivir (10.5%); 18.6% experienced severe COVID-19 pneumonia (evidenced by ventilator requirement). Neuropsychiatric complications occurred in 58.8% of patients; 39.8% experienced AMS; and 19.0% experienced at least one other complication (seizures in 1.4%, ischemic stroke in 1.6%, hemorrhagic stroke in 1.0%) or symptom (headache in 11.4%, anxiety in 6.8%, ataxia in 6.3%). Higher odds of mortality, which occurred in 22.0%, were associated with AMS, ventilator support, increasing age, and higher serum inflammatory marker levels. Anticoagulant therapy was associated with lower odds of mortality and AMS.

Conclusion

Neuropsychiatric complications of COVID-19, especially AMS, were common, varied, and associated with in-hospital mortality in a diverse multicenter cohort at an epicenter of the COVID-19 pandemic.

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Data availability

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

We dedicate this work to the patients and healthcare workers in the Mount Sinai Health System during the COVID-19 pandemic.

Funding

No study funding was received.

Author information

Author notes

  1. Kapil Gururangan and Veronica J. Peschansky contributed equally.

Authors and Affiliations

  1. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Kapil Gururangan, Veronica J. Peschansky, Parul Agarwal, Leah J. Blank, Brian Mathew, Jonathan Goldstein, Louise McCarthy, Ariella Cohen, Andy Ho Wing Chan, Pojen Deng, Mandip Dhamoon, Eveline Gutzwiller, Qing Hao, Celestine He, Britany Klenofsky, Hernan Nicolas Lemus, Lara Marcuse, Allison Navis, Wilson D. Heredia Nunez, Mallory N. Luckey, Emily M. Schorr, Anuradha Singh, Gabriela B. Tantillo, Claire Ufongene, James J. Young, Joanne R. Festa, Georges Naasan & Nathalie Jetté

  2. Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Kapil Gururangan

  3. Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA

    Veronica J. Peschansky

  4. Department of Population Health Science and Policy, Institute of Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Grace Van Hyfte, Parul Agarwal, Leah J. Blank & Nathalie Jetté

  5. Departments of Neurosurgery, Neurology, Epidemiology, and the Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA

    Churl-Su Kwon

  6. Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA

    Hernan Nicolas Lemus

  7. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Emily M. Schorr

  8. Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    Gabriela B. Tantillo

  9. BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Priti Balchandani

  10. The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Joanne R. Festa & Georges Naasan

  11. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Alexander W. Charney

  12. Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Alexander W. Charney

  13. Division of Data Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Girish N. Nadkarni

  14. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada

    Nathalie Jetté

Authors
  1. Kapil Gururangan
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  2. Veronica J. Peschansky
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  3. Grace Van Hyfte
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  4. Parul Agarwal
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  6. Brian Mathew
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  7. Jonathan Goldstein
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  8. Churl-Su Kwon
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  9. Louise McCarthy
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  10. Ariella Cohen
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  11. Andy Ho Wing Chan
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  14. Eveline Gutzwiller
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  15. Qing Hao
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  16. Celestine He
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  17. Britany Klenofsky
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  18. Hernan Nicolas Lemus
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  19. Lara Marcuse
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  20. Allison Navis
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  21. Wilson D. Heredia Nunez
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  22. Mallory N. Luckey
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  23. Emily M. Schorr
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  24. Anuradha Singh
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  25. Gabriela B. Tantillo
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  26. Claire Ufongene
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  27. James J. Young
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  28. Priti Balchandani
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  29. Joanne R. Festa
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  30. Georges Naasan
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  31. Alexander W. Charney
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  32. Girish N. Nadkarni
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  33. Nathalie Jetté
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for the Sinai NeuroCOVID-19 Study Group

Corresponding author

Correspondence to Nathalie Jetté.

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Conflicts of interest

KG serves as a clinical and scientific advisor to Ceribell Inc., receives consulting fees for research contributions unrelated to this work, and owns stock options in Ceribell Inc.; he received grant funding paid to his institution from NINDS (NIH R25NS079102) and the Leon Levy Foundation; and he serves as a review editor for Frontiers in Neurology-Epilepsy. VJP received grant funding paid to her institution from NINDS (NIH R25NS079102) and the Leon Levy Foundation. PA received grant funding paid to her institution from NICHD (NIH R01HD100544), NIH (PD22-01299) and SU2C 6209, and she receives an honorarium for her work as an assistant editor of Statistics of Anesthesia & Analgesia. LJB received research support from the American Epilepsy Society, Epilepsy Foundation, NORSE Institute, NIA (NIH T32AG066598), Mount Sinai Claude D. Pepper Older American Independence Center (5P30AG028741-11), and Icahn School of Medicine Department of Neurology. CSK received research support from the American Epilepsy Society as well as grant funding paid to his institution from the Leon Levy Foundation. EMS received fellowship funding paid to her institution from Biogen. CU was funded by the Medical Student Training in Aging Research program sponsored by the National Institute of Aging. JJY received research support from Monteris for unrelated work and grant funding paid to his institution from NINDS (R25NS8440304) and the Leon Levy Foundation. PB received grant funding paid to her institution from NCI (NIH R01CA202911), NIMH (NIH R01MH116953), NIA (NIH R21AG076211), NIDCR (NIH R56DE030680), and NINDS (NIH R00NS070821, NIH R21NS122389). GN received an honorarium for advisory work from Genentech. AWC received grant funding paid to his institution from NIMH (NIH U01MH109536, NIH R01MH121923, NIH R01MH130662) and NIA (NIH R01AG069976). GNN received grant funding paid to his institution from NIDDK (NIH K23DK107908, NIH R01DK127139, NIH U01DK133093) and NHLBI (NIH R01HL155915). NJ received grant funding paid to her institution from NINDS (NIH U24NS107201, NIH U54NS100064, NIH U24NS113849), the American Epilepsy Society, and the NORSE Institute during the study period; she receives an honorarium for her work as an associate editor of Epilepsia, and she was the Icahn School of Medicine Bludhorn Professor of International Medicine. The remaining authors report no conflicts of interest or disclosures.

Ethical approval

The study was approved by the Icahn School of Medicine Institutional Review Board (IRB-20–03271) and conducted in accordance with the World Medical Association Declaration of Helsinki. Due to the retrospective nature of the study, informed consent was not required.

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Gururangan, K., Peschansky, V.J., Van Hyfte, G. et al. Neuropsychiatric complications of coronavirus disease 2019: Mount Sinai Health System cohort study. J Neurol (2024). https://doi.org/10.1007/s00415-024-12370-9

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