Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS)

the LEOSS Study Group

doi:10.1111/ene.15072

Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS)

the LEOSS Study Group

Abstract

Background and purpose: During acute coronavirus disease 2019 (COVID-19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real-world data from a multinational registry. Methods: We analyzed COVID-19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS-Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. Results: A total of 6537 COVID-19 patients (97.7% PCR-confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB; 2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20–1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07–1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19. Conclusion: Our data on mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICB in critical COVID-19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life-threatening systemic viral infection.

Original language	English
Journal	European Journal of Neurology
ISSN	1351-5101
DOIs	https://doi.org/10.1111/ene.15072
Publication status	Published - 12.2021

Funding

Nina N.Kleineberg, Samuel Knauss and Eileen Gülke thank the German Neurological Society (DGN) for their support funding the analyses for this study. Samuel Knauss is a participant in the BIH‐Charité Digital Clinician Scientist Program funded by the Charité Universitätsmedizin Berlin and the Berlin Institute of Health. We express our deep gratitude to all study teams supporting the LEOSS study. The LEOSS study group contributed at least 5 per mille of the patients to the analyses of this study: Technical University of Munich (Christoph Spinner), University Hospital Regensburg (Frank Hanses), Hospital Passau (Julia Lanzster), Hospital Ingolstadt (Stefan Borgmann), University Hospital Düsseldorf (Björn Jensen), University Hospital Frankfurt (Maria Vehreschild), Hospital Dortmund (Martin Hower), University Hospital Jena (Maria Madeleine Rüthrich), University Hospital Freiburg (Siegbert Rieg), Robert‐Bosch‐Hospital Stuttgart (Katja Rothfuss), Hospital Bremen‐Center (Christiane Piepel), Practice at Ebertplatz (Christopf Wyen), University Hospital Augsburg (Christoph Römmele), Hospital Leverkusen (Lukas Eberwein), St. Josef‐Hospital – Catholic Hospital Bochum (Kerstin Hellwig), University Hospital Schleswig‐Holstein – Lübeck (Kadja Käding), Johannes Wesling Hospital Minden (Kai Wille), Municipal Hospital Karlsruhe (Christian Degenhardt), Maria Hilf Hospital (Hendrik Haake), St. Josef Hospital Kupferdreh (Ingo Voigt), Hospital Ernst von Bergmann (Lukas Tometten), Evangelisches Stadtkrankenhaus Saarbrücken (Mark Neufang), University Hospital Cologne (Norma Jung) University Hospital Essen (Sebastian Dolff), University Hospital Heidelberg (Uta Merle), Marien Hospital Herne, University Hospital Bochum (Beate Schultheis), Tropical Clinic Paul‐Lechler Hospital Tübingen (Claudia Raichle), University Hospital Munich/ LMU (Michael von Bergwelt‐Baildon), University Hospital Tübingen (Siri Göpel), University Hospital Erlangen (Richard Strauß), Bundeswehr Hospital Koblenz (Dominic Rauschning), University Hospital Würzburg (Nora Isberner), Hospital St. Joseph‐Stift Dresden (Lorenz Walter), Maltese Hospital St. Franziskus‐Hospital Flensburg (Mile Milovanovic), MS Center Belgium (Marie D'Hooghe), Center for Infectiology Berlin/Prenzlauer Berg (Stephan Grunwald), Hacettepe University (Murat Akova), Hospital Fulda (Philipp Markart), University Hospital Ulm (Beate Grüner), Braunschweig Hospital (Jan Kielstein), Clinic Munich (Wolfgang Guggemos), Justus‐Liebig‐University Giessen (Janina Trauth), Agaplesion Diaconia Hospial Rotenburg (David Heigener), Medical School Hannover (Gernot Beutel), Pauls Stradins Clinical, University Hospital (Alise Gramatniece), University Hospital Dresden (Katja de With), University Hospital Saarland (Robert Bals), University Hospital Schleswig‐Holstein ‐ Kiel (Anette Friedrichs), Hospital of the Augustinian Cologne (Stefani Röseler), Practice for general medicine Drs. Elisabeth Schrödter & Gabriele Müller‐Jörger (Gabriele Müller‐Jörger), Hospital Osnabrück (Annika Ritter). The LEOSS study infrastructure group: Jörg Janne Vehreschild (Goethe University Frankfurt), Lisa Pilgram (Goethe University Frankfurt), Carolin E. M. Jakob (University Hospital of Cologne), Melanie Stecher (University Hospital of Cologne), Max Schons (University Hospital of Cologne), Susana Nunes de Miranda (University Hospital of Cologne), Nick Schulze (University Hospital of Cologne), Sandra Fuhrmann (University Hospital of Cologne), Annika Claßen (University Hospital of Cologne), Bernd Franke (University Hospital of Cologne), Fabian Praßer (Charité, Universitätsmedizin Berlin) and Martin Lablans (University Medical Center Mannheim). Open Access funding enabled and organized by Projekt DEAL. WOA Institution: Uniklinik Koln Blended DEAL: Projekt DEAL.

Research Areas and Centers

Research Area: Medical Genetics

DFG Research Classification Scheme

2.23-02 Molecular Biology and Physiology of Nerve and Glial Cells

Coronavirus related work

Research on SARS-CoV-2 / COVID-19

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/ene.15072

Cite this

@article{765034e50c46410abb8c8c03f2b32051,

title = "Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS)",

abstract = "Background and purpose: During acute coronavirus disease 2019 (COVID-19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real-world data from a multinational registry. Methods: We analyzed COVID-19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS-Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. Results: A total of 6537 COVID-19 patients (97.7\% PCR-confirmed) were analyzed, of whom 92.1\% were hospitalized and 14.7\% died. Commonly, excessive tiredness (28.0\%), headache (18.5\%), nausea/emesis (16.6\%), muscular weakness (17.0\%), impaired sense of smell (9.0\%) and taste (12.8\%), and delirium (6.7\%) were reported. In patients with a complicated or critical disease course (53\%) the most frequent neurological complications were ischemic stroke (1.0\%) and intracerebral bleeding (ICB; 2.2\%). ICB peaked in the critical disease phase (5\%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95\% confidence interval [CI] 1.20–1.68) and prior neurodegenerative diseases (OR 1.32, 95\% CI 1.07–1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19. Conclusion: Our data on mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICB in critical COVID-19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life-threatening systemic viral infection.",

author = "\{the LEOSS Study Group\} and Kleineberg, \{Nina N.\} and Samuel Knauss and Eileen G{\"u}lke and Pinnschmidt, \{Hans O.\} and Jakob, \{Carolin E.M.\} and Paul Lingor and Kerstin Hellwig and Achim Berthele and G{\"u}nter H{\"o}glinger and Fink, \{Gereon R.\} and Matthias Endres and Christian Gerloff and Christine Klein and Melanie Stecher and Classen, \{Annika Y.\} and Siegbert Rieg and Stefan Borgmann and Frank Hanses and R{\"u}thrich, \{Maria M.\} and Martin Hower and Lukas Tometten and Martina Haselberger and Christiane Piepel and Uta Merle and Sebastian Dolff and Christian Degenhardt and Jensen, \{Bj{\"o}rn Erik O.\} and Maria Vehreschild and Johanna Erber and Christiana Franke and Clemens Warnke and Christoph Spinner and Frank Hanses and Julia Lanzster and Stefan Borgmann and Bj{\"o}rn Jensen and Maria Vehreschild and Martin Hower and R{\"u}thrich, \{Maria Madeleine\} and Siegbert Rieg and Katja Rothfuss and Christiane Piepel and Christopf Wyen and Christoph R{\"o}mmele and Lukas Eberwein and Kerstin Hellwig and Kadja K{\"a}ding and Kai Wille and Christian Degenhardt and Hendrik Haake",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors. European Journal of Neurology published by John Wiley \& Sons Ltd on behalf of European Academy of Neurology.",

year = "2021",

month = dec,

doi = "10.1111/ene.15072",

language = "English",

journal = "European Journal of Neurology",

issn = "1351-5101",

publisher = "Wiley-Blackwell Publishing Ltd",

}

TY - JOUR

T1 - Neurological symptoms and complications in predominantly hospitalized COVID-19 patients

T2 - Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS)

AU - the LEOSS Study Group

AU - Kleineberg, Nina N.

AU - Knauss, Samuel

AU - Gülke, Eileen

AU - Pinnschmidt, Hans O.

AU - Jakob, Carolin E.M.

AU - Lingor, Paul

AU - Hellwig, Kerstin

AU - Berthele, Achim

AU - Höglinger, Günter

AU - Fink, Gereon R.

AU - Endres, Matthias

AU - Gerloff, Christian

AU - Klein, Christine

AU - Stecher, Melanie

AU - Classen, Annika Y.

AU - Rieg, Siegbert

AU - Borgmann, Stefan

AU - Hanses, Frank

AU - Rüthrich, Maria M.

AU - Hower, Martin

AU - Tometten, Lukas

AU - Haselberger, Martina

AU - Piepel, Christiane

AU - Merle, Uta

AU - Dolff, Sebastian

AU - Degenhardt, Christian

AU - Jensen, Björn Erik O.

AU - Vehreschild, Maria

AU - Erber, Johanna

AU - Franke, Christiana

AU - Warnke, Clemens

AU - Spinner, Christoph

AU - Hanses, Frank

AU - Lanzster, Julia

AU - Borgmann, Stefan

AU - Jensen, Björn

AU - Vehreschild, Maria

AU - Hower, Martin

AU - Rüthrich, Maria Madeleine

AU - Rieg, Siegbert

AU - Rothfuss, Katja

AU - Piepel, Christiane

AU - Wyen, Christopf

AU - Römmele, Christoph

AU - Eberwein, Lukas

AU - Hellwig, Kerstin

AU - Käding, Kadja

AU - Wille, Kai

AU - Degenhardt, Christian

AU - Haake, Hendrik

PY - 2021/12

Y1 - 2021/12

N2 - Background and purpose: During acute coronavirus disease 2019 (COVID-19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real-world data from a multinational registry. Methods: We analyzed COVID-19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS-Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. Results: A total of 6537 COVID-19 patients (97.7% PCR-confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB; 2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20–1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07–1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19. Conclusion: Our data on mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICB in critical COVID-19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life-threatening systemic viral infection.

AB - Background and purpose: During acute coronavirus disease 2019 (COVID-19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real-world data from a multinational registry. Methods: We analyzed COVID-19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS-Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. Results: A total of 6537 COVID-19 patients (97.7% PCR-confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB; 2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20–1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07–1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short-term outcome of COVID-19. Conclusion: Our data on mostly hospitalized COVID-19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short-term outcome. ICB in critical COVID-19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life-threatening systemic viral infection.

UR - https://www.scopus.com/pages/publications/85114762588

U2 - 10.1111/ene.15072

DO - 10.1111/ene.15072

M3 - Journal articles

C2 - 34411383

AN - SCOPUS:85114762588

SN - 1351-5101

JO - European Journal of Neurology

JF - European Journal of Neurology

ER -

Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS)

Abstract

Funding

Research Areas and Centers

DFG Research Classification Scheme

Coronavirus related work

UN SDGs

Access to Document

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Cite this