Misra, Shubham, Kolappa, Kavitha, Prasad, Manya, Radhakrishnan, Divya, Thakur, Kiran T, Solomon, Tom 
ORCID: 0000-0001-7266-6547, Michael, Benedict Daniel ORCID: 0000-0002-8693-8926, Winkler, Andrea Sylvia, Beghi, Ettore, Guekht, Alla et al (show 13 more authors)
(2021)
Frequency of Neurologic Manifestations in COVID-19 A Systematic Review and Meta-analysis.
NEUROLOGY, 97 (23).
E2269-E2281.
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Author Accepted MS - Frequency of neurological manifestations in COVID-19 a systematic review and meta-analysis.pdf - Author Accepted Manuscript Download (411kB) | Preview |
Abstract
<h4>Background and objectives</h4>One year after the onset of the coronavirus disease 2019 (COVID-19) pandemic, we aimed to summarize the frequency of neurologic manifestations reported in patients with COVID-19 and to investigate the association of these manifestations with disease severity and mortality.<h4>Methods</h4>We searched PubMed, Medline, Cochrane library, ClinicalTrials.gov, and EMBASE for studies from December 31, 2019, to December 15, 2020, enrolling consecutive patients with COVID-19 presenting with neurologic manifestations. Risk of bias was examined with the Joanna Briggs Institute scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% confidence intervals (CIs) were calculated for neurologic manifestations. Odds ratio (ORs) and 95% CIs were calculated to determine the association of neurologic manifestations with disease severity and mortality. Presence of heterogeneity was assessed with <i>I</i> <sup>2</sup>, meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2.<h4>Results</h4>Of 2,455 citations, 350 studies were included in this review, providing data on 145,721 patients with COVID-19, 89% of whom were hospitalized. Forty-one neurologic manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurologic symptoms included fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%), and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurologic diagnosis (pooled prevalence 2%). In patients with COVID-19 ≥60 years of age, the pooled prevalence of acute confusion/delirium was 34%, and the presence of any neurologic manifestations in this age group was associated with mortality (OR 1.80, 95% CI 1.11-2.91).<h4>Discussion</h4>Up to one-third of patients with COVID-19 analyzed in this review experienced at least 1 neurologic manifestation. One in 50 patients experienced stroke. In those >60 years of age, more than one-third had acute confusion/delirium; the presence of neurologic manifestations in this group was associated with nearly a doubling of mortality. Results must be interpreted with the limitations of observational studies and associated bias in mind.<h4>Systematic review registration</h4>PROSPERO CRD42020181867.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Delirium, Stroke, Observational Studies as Topic, COVID-19, SARS-CoV-2 |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 13 Jan 2022 11:35 |
| Last Modified: | 18 Jan 2023 21:16 |
| DOI: | 10.1212/WNL.0000000000012930 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3146451 |
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