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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(02): 146-154
DOI: 10.1055/s-0043-1761433
Original Article

Neurological symptoms and comorbidity profile of hospitalized patients with COVID-19

Sintomas neurológicos e perfil de comorbidades de pacientes hospitalizados com COVID-19
Renata Carvalho Cremaschi 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Carla Alessandra Scorza Bahi 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Angelo Amato Vincenzo de Paola 
2   Universidade Federal de São Paulo, Departamento de Medicina, São Paulo SP, Brazil.
,
Jaquelina Sonoe Ota Arakaki 
2   Universidade Federal de São Paulo, Departamento de Medicina, São Paulo SP, Brazil.
,
Paulo Roberto Abrão Ferreira 
2   Universidade Federal de São Paulo, Departamento de Medicina, São Paulo SP, Brazil.
,
Nancy Cristina Junqueira Bellei 
2   Universidade Federal de São Paulo, Departamento de Medicina, São Paulo SP, Brazil.
,
Vanderci Borges 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Fernando Morgadinho Santos Coelho 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
3   Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.
› Institutsangaben Support This work was supported by the Hospital São Paulo and the Department of Neurology and Neurosurgery, Federal University of São Paulo, Brazil.
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Abstract

Background The neurological manifestations in COVID-19 adversely impact acute illness and post-disease quality of life. Limited data exist regarding the association of neurological symptoms and comorbid individuals.

Objective To assess neurological symptoms in hospitalized patients with acute COVID-19 and multicomorbidities.

Methods Between June 2020 and July 2020, inpatients aged 18 or older, with laboratory-confirmed COVID-19, admitted to the Hospital São Paulo (Federal University of São Paulo), a tertiary referral center for high complexity cases, were questioned about neurological symptoms. The Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire was used. The data were analyzed as a whole and whether subjective olfactory dysfunction was present or not.

Results The mean age of the sample was 55 ± 15.12 years, and 58 patients were male. The neurological symptoms were mostly xerostomia (71%), ageusia/hypogeusia (50%), orthostatic intolerance (49%), anosmia/hyposmia (44%), myalgia (31%), dizziness (24%), xerophthalmia (20%), impaired consciousness (18%), and headache (16%). Furthermore, 91% of the patients had a premorbidity. The 44 patients with subjective olfactory dysfunction were more likely to have hypertension, diabetes, weakness, shortness of breath, ageusia/hypogeusia, dizziness, orthostatic intolerance, and xerophthalmia. The COMPASS-31 score was higher than that of previously published controls (14.85 ± 12.06 vs. 8.9 ± 8.7). The frequency of orthostatic intolerance was 49% in sample and 63.6% in those with subjective olfactory dysfunction (2.9-fold higher risk compared to those without).

Conclusion A total of 80% of inpatients with multimorbidity and acute COVID-19 had neurological symptoms. Chemical sense and autonomic symptoms stood out. Orthostatic intolerance occurred in around two-thirds of the patients with anosmia/hyposmia. Hypertension and diabetes were common, mainly in those with anosmia/hyposmia.

Resumo

Antecedentes As manifestações neurológicas na COVID-19 impactam adversamente na enfermidade aguda e na qualidade de vida após a doença. Dados limitados existem em relação a associação de sintomas neurológicos e indivíduos com comorbidades.

Objetivo Avaliar os sintomas neurológicos em pacientes de hospitalizados com COVID-19 aguda e múltiplas comorbidades.

Métodos Entre junho e julho de 2020, pacientes de hospitais com idade 18 anos ou acima e COVID-19 laboratorialmente confirmada, admitidos no Hospital São Paulo (Universidade Federal de São Paulo), um centro de referência terciário para casos de alta complexidade, foram perguntados sobre sintomas neurológicos. O questionário Pontuação composta de sintoma autonômico (COMPASS-31) foi usado. Os dados foram analisados no geral e se a disfunção olfatória subjetiva estava presente ou não.

Resultados A média de idade da amostra foi 55 ± 15.12 anos. 58 pacientes eram homens. Os sintomas neurológicos foram principalmente xerostomia (71%), ageusia/hipogeusia (50%), intolerância ortostática (49%), anosmia/hiposmia (44%), mialgia (31%), tontura (24%), xeroftalmia (20%), comprometimento na consciência (18%) e cefaleia (16%). Além disso, 91% dos pacientes tinham uma pré-morbidade. Os 44 pacientes com disfunção olfatória tinham maior chance de ter hipertensão, diabetes, fraqueza, falta de ar, ageusia/hipogeusia, tontura, intolerância ortostática e xeroftalmia. A pontuação do COMPASS-31 foi maior do que a de controles previamente publicados (14,85 ± 12,06 vs. 8,9 ± 8,7). A frequência de intolerância ortostática foi 49% na amostra e 63,6% naqueles com disfunção olfatória subjetiva (risco 2.9 vezes maior comparado com os sem).

Conclusão Um total de 80% dos pacientes hospitalizados com múltiplas morbidades e COVID-19 aguda tinham sintomas neurológicos. Os sintomas do sentido químico e autonômicos se destacaram. A intolerância ortostática ocorreu em cerca de dois terços dos pacientes com anosmia/hiposmia. A hipertensão e o diabetes foram comuns, principalmente naqueles com anosmia/hiposmia.

Keywords

COVID-19 - Neurologic Manifestations - Comorbidity - Anosmia - Orthostatic Intolerance - Autonomic Nervous System Diseases

Palavras-chave

COVID-19 - Manifestações Neurológicas - Comorbidade - Anosmia - Intolerância Ortostática - Doenças do Sistema Nervoso Autônomo

Authors' Contributions

RCC, FMC, CAS, JSOA, PAAF, NCJB, VB: research idea and study design, drafting or revision of manuscript; RCC, FMC: data acquisition and interpretation, statistical analysis.


Supplementary Material



Publikationsverlauf

Eingereicht: 16. Februar 2022

Angenommen: 05. Juni 2022

Artikel online veröffentlicht:
22. März 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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