COVID-19 outcomes of 10,881 patients: retrospective study of neurological symptoms and associated manifestations (Philippine CORONA Study)
Adrian I. Espiritu, Marie Charmaine C. Sy, Veeda Michelle M. Anlacan, Roland Dominic G. Jamora, the Philippine CORONA Study Group Investigators, Corina Maria Socorro A. Macalintal, Joanne B. Robles, Paulo Cataniag, Manolo Kristoffer C. Flores, Noreen Jhoanna C. Tangcuangco-Trinidad, Dan Neftalie A. Juangco, Giuliani Renz G. Paas, Audrey Marie U. Chua, Valmarie S. Estrada, Philip Rico P. Mejia, Therese Franz B. Reyes, Maria Teresa A. Cañete, Ferdinand Renfred A. Zapata, Franko Eugenio B. Castillo, Romulo U. Esagunde, Jean B. Gantioque, Maritoni C. Abbariao, Geramie M. Acebuque, Evram V. Corral, Marian Irene C. Escasura, Marissa Ong, Krizelle Cleo Fowler, Arnold Angelo M. Pineda, Khasmeen D. Aradani, Joseree‐Ann S. Catindig, Mark Timothy T. Cinco, Mark Ramos, Romulus Emmanuel H. Cruz, Marita B. Dantes, Norberto A. Francisco, Rosalia A. Teleg, Krisverlyn B. Bellosillo, Jean Paolo M. Delfino, Cid Czarina E. Diesta, R. Espiritu-Picar, Julie Anne V. Gamboa, Cara Camille M. Matute, Franzelle P. Padilla, John Joshua Q. Punsalan, Ma. Epifania V. Collantes, Charmaine B. Que, Hanifa A. Sampao, Maxine Camela S. Sta. Maria, Marita M. Fuentes, Jennifer Justice F. Manzano, Rizza J. Umali, Marc Conrad C. Molina, Hazel Claire Minerva-Ang, Arturo F. Surdilla, Loreto P. Talabucon, Natasha F. Wabe, Maria Victoria G. Manuel, Al Inde John A. Pajantoy, Josephine Cecilia V. Roque, Paul Emmanuel L. Yambao, Christian Paul B. Banday, Chritopher C. Cipriano, Nehar A. Pangandaman, Avery Gail C. Wasil, Elrey P. Inocian, J.A. Vatanagul, Almira Doreen Abigail O. Apor, Carissa Paz C. Dioquino, Prinz Andrew M. Dela Cruz, Maricar P. Yumul, Ma. Alma E. Carandang-Concepcion, Ma. Caridad V. Desquitado, Carl Kevin L. Julao, Dante P. Bornales, Generaldo D. Maylem, Mark Joseph F. Cuntapay, Annabelle Y. Lao-Reyes, Aileen Mae B. Lee, Nadia O. Manlegro, Dave Mar L. Pelere, Lina Laxamana, Diana-Lynn S. Que, Jeryl Ritzi T. Yu, M Martinez, Alexandria Matic, John Angelo Luigi S. Perez, Glenn Anthony A. Constantino, Aldanica R. Olano, Liz Edenberg P. Quiles, Artemio Roxas, Jo Ann R Soliven, Michael Dorothy Frances Montojo-Tamayo, Ma. Lourdes C. Joson, Jojo R. Evangelista, Ma. Clarissa B. Nuñez, Marietta C. Olaivar, Dominique Q. Perez, Mark Deneb O. Armeña, Robert A. Barja, Joshua Emmanuel E. Abejero
Abstract
Our study aimed to determine the effects of new-onset neurological symptoms (NNS) on clinically relevant outcomes in hospitalized patients with COVID-19 infection. We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines. We included a total of 10,881 patients with confirmed COVID-19 infection (2008 had NNS while 8873 did not have NNS). The adjusted hazard ratios (aHRs) for mortality among the mild and severe cases were significantly higher by 1.660 (95% CI 1.132-2.435) and by 1.352 (95% CI 1.042-1.752), respectively, in the NNS group compared to those in the non-NNS group. The aHRs for respiratory failure in the NNS group were significantly increased by 1.914 (95% CI 1.346-2.722), by 1.614 (95% CI 1.260-2.068), and by 1.234 (95% CI 1.089-1.398) among the mild, severe, and critical cases, respectively. The aHRs for ICU admission in the NNS group were still significantly higher by 1.973 (95% CI 1.457-2.673) and by 1.831 (95% CI 1.506-2.226) among the mild and severe cases, respectively. Patients who had NNS were not significantly associated with a longer duration of ventilator dependence (adjusted odds ratio (aOR) 0.954, 95% CI 0.772-1.179), longer ICU stay (aOR 0.983, 95% CI 0.772-1.252) and longer hospital admission (aOR 1.045, 95% CI 0.947-1.153). The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients. Registration and associated protocol publication: ClinicalTrials.gov website (NCT04386083); Espiritu AI, Sy MCC, Anlacan VMM, Jamora RDG. The Philippine COVID-19 Outcomes: a Retrospective study Of Neurological manifestations and Associated symptoms (The Philippine CORONA study): a protocol study. BMJ Open. 2020;10:e040944.