Neurological diagnoses in hospitalized COVID-19 patients associated with adverse outcomes: A multinational cohort study.

Autor:	Hutch MR; Department of Preventive Medicine, Northwestern University, Chicago, Illinois, United States of America., Son J; Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America., Le TT; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America., Hong C; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America.; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States of America., Wang X; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States of America., Shakeri Hossein Abad Z; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Morris M; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America., Gutiérrez-Sacristán A; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Klann JG; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America., Spiridou A; Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, London, United Kingdom., Batugo A; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America., Bellazzi R; Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy., Benoit V; IT Department, Innovation & Data, APHP Greater Paris University Hospital, Paris, France., Bonzel CL; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Bryant WA; Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, London, United Kingdom., Chiudinelli L; UOC Ricerca, Innovazione e Brand reputation, ASST Papa Giovanni XXIII, Bergamo, Italy., Cho K; Population Health and Data Science, VA Boston Healthcare System, Boston Massachusetts, United States of America.; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston Massachusetts, United States of America., Das P; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., González González T; Health Informatics, Hospital Universitario 12 de Octubre, Madrid, Spain., Hanauer DA; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, United States of America., Henderson DW; Center for Clinical and Translational Science, University of Kentucky, Lexington, Kentucky, United States of America., Ho YL; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston Massachusetts, United States of America., Loh NHW; Department of Anaesthesia, National University Health System, Kent Ridge, Singapore., Makoudjou A; Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany., Makwana S; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Malovini A; Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy., Moal B; IAM Unit, Bordeaux University Hospital, Bordeaux, France., Mowery DL; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America., Neuraz A; Department of biomedical informatics, Hôpital Necker-Enfants Malade, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, Paris, France., Samayamuthu MJ; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America., Sanz Vidorreta FJ; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America., Schriver ER; Data Analytics Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States of America., Schubert P; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston Massachusetts, United States of America., Talbert J; Division of Biomedical Informatics, University of Kentucky, Lexington, Kentucky, United States of America., Tan ALM; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Tan BWL; Department of Medicine, National University Hospital, Singapore, Kent Ridge, Singapore., Tan BWQ; Department of Medicine, National University Hospital, Singapore, Kent Ridge, Singapore., Tibollo V; Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy., Tippman P; Institute of Medical Biometry and University of Freiburg, Medical Center, Freiburg, Germany., Verdy G; IAM Unit, Bordeaux University Hospital, Bordeaux, France., Yuan W; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Avillach P; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Gehlenborg N; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Omenn GS; Departments of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, Public Health, University of Michigan, Ann Arbor, Michigan, United States of America., Visweswaran S; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America., Cai T; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America., Luo Y; Department of Preventive Medicine, Northwestern University, Chicago, Illinois, United States of America., Xia Z; Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS digital health [PLOS Digit Health] 2024 Apr 15; Vol. 3 (4), pp. e0000484. Date of Electronic Publication: 2024 Apr 15 (Print Publication: 2024).
DOI:	10.1371/journal.pdig.0000484
Abstrakt:	Few studies examining the patient outcomes of concurrent neurological manifestations during acute COVID-19 leveraged multinational cohorts of adults and children or distinguished between central and peripheral nervous system (CNS vs. PNS) involvement. Using a federated multinational network in which local clinicians and informatics experts curated the electronic health records data, we evaluated the risk of prolonged hospitalization and mortality in hospitalized COVID-19 patients from 21 healthcare systems across 7 countries. For adults, we used a federated learning approach whereby we ran Cox proportional hazard models locally at each healthcare system and performed a meta-analysis on the aggregated results to estimate the overall risk of adverse outcomes across our geographically diverse populations. For children, we reported descriptive statistics separately due to their low frequency of neurological involvement and poor outcomes. Among the 106,229 hospitalized COVID-19 patients (104,031 patients ≥18 years; 2,198 patients <18 years, January 2020-October 2021), 15,101 (14%) had at least one CNS diagnosis, while 2,788 (3%) had at least one PNS diagnosis. After controlling for demographics and pre-existing conditions, adults with CNS involvement had longer hospital stay (11 versus 6 days) and greater risk of (Hazard Ratio = 1.78) and faster time to death (12 versus 24 days) than patients with no neurological condition (NNC) during acute COVID-19 hospitalization. Adults with PNS involvement also had longer hospital stay but lower risk of mortality than the NNC group. Although children had a low frequency of neurological involvement during COVID-19 hospitalization, a substantially higher proportion of children with CNS involvement died compared to those with NNC (6% vs 1%). Overall, patients with concurrent CNS manifestation during acute COVID-19 hospitalization faced greater risks for adverse clinical outcomes than patients without any neurological diagnosis. Our global informatics framework using a federated approach (versus a centralized data collection approach) has utility for clinical discovery beyond COVID-19. Competing Interests: All authors report no competing interests or conflicts of interest. JGK reports a consulting relationship with the i2b2-tranSMART Foundation through Invocate, Inc. RB reports being a shareholder of Biomeris s.r.l. and Engenome s.r.l. DAH reports entitled to royalties from the University of Michigan for licensing of the EMERSE "synonyms". AM’s work is being funded by the Federal Ministry of Education and Research (BMBF) in Germany in the framework of the MIRACUM Consortium. AM reports being a shareholder of Biomeris s.r.l. BM reports being co-founder and equity owner from DESKI. DLM has received research support from the National Institutes of Health, Department of Veteran Affairs, and the University of Pittsburgh/Pittsburgh Health Data Alliance outside of this work. PA reports consulting for CCHMC and BCH. NG is a co-founder and equity owner of Datavisyn. ZX has served as a Consultant for Genentech/Roche. The institution of ZX has received research support from the National Institute of Health, the National Multiple Sclerosis Society, Food and Drug Administration, the Pittsburgh Foundation, the PNC Charitable Trust, the Ethel Vincent Trust, and Genentech / Roche. (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Databáze:	MEDLINE
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