Clinical profile and prognosis of COVID-19 patients with neurological manifestations: A city-wide cross- sectional study in Iran

Abstract

Background & Objective: In this study, we aimed to evaluate past medical and social history, initial symptoms, laboratory values, clinical course, and outcome of COVID-19 patients with neurological manifestations in Shahroud, Iran.

Methods: In this cross-sectional study, data from all registered COVID-19 patients in Shahroud during March 2020 to July 2021 (n=30,228) were initially reviewed in terms of the prevalence of neurological symptoms. Additionally, the data of COVID-19 patients admitted to Shahroud’s hospital (n=8,412) was evaluated in details according to the clinical profile, socio-demographic characteristics, laboratory findings, and in-hospital outcomes. Data were compared between COVID-19 patients with and without neurological manifestations. Predictive factors of ICU admission and mortality in COVID-19 patients with neurological manifestations were also evaluated.

Results: Fever, chills, anorexia, myalgia, arthralgia, nausea, vomiting, cough, dyspnea, diarrhea and abdominal pain were significantly more common among COVID-19 patients with neurological symptoms compared to COVID-19 patients without such symptoms. Furthermore, smoking, drug abuse and history of underlying diseases were significantly more prevalent among the former group. Patients with neurological symptoms were more likely to be admitted to the hospital and ICU and had higher mortality rates. In terms of laboratory findings, hemoglobin, hematocrit, platelet count, and albumin levels were significantly lower in the patients with neurological symptoms. Age ≥ 50 years and history of underlying diseases were associated with increased ICU admission in COVID-19 patients with neurological manifestations.

Conclusions: The following strategies could prove beneficial for COVID-19 patients: (i.) reduction of smoking and substance abuse, (ii.) close monitoring of more symptomatic patients and patients with a history of underlying diseases for neurological manifestations, (iii.) providing appropriate intensive care for older patients and those with underlying diseases who have neurological manifestations and (iv.) early detection of anemia, thrombocytopenia, and hypoalbuminemia.