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, Philippine CORONA Study Group Investigators, Corina Maria Socorro A Macalintal, Joanne B Robles, Paulo L 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 T Ong, Krizelle Cleo Fowler, Arnold Angelo M Pineda, Khasmeen D Aradani, Joseree-Ann S Catindig, Mark Timothy T Cinco, Mark Erving H 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, Rosalina B 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, Jarungchai Anton S 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 C Laxamana, Diana-Lynn S Que, Jeryl Ritzi T Yu, Ma Socorro C Martinez, Alexandria E Matic, John Angelo Luigi S Perez, Glenn Anthony A Constantino, Aldanica R Olano, Liz Edenberg P Quiles, Artemio A Roxas Jr, 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, Maritzie R Eribal, Ryndell G Alava, Muktader A Kalbi, Nasheera W Radja, Mohammad Elshad S Sali, Adrian I Espiritu, Marie Charmaine C Sy, Veeda Michelle M Anlacan, Roland Dominic G Jamora, Philippine CORONA Study Group Investigators, Corina Maria Socorro A Macalintal, Joanne B Robles, Paulo L 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 T Ong, Krizelle Cleo Fowler, Arnold Angelo M Pineda, Khasmeen D Aradani, Joseree-Ann S Catindig, Mark Timothy T Cinco, Mark Erving H 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, Rosalina B 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, Jarungchai Anton S 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 C Laxamana, Diana-Lynn S Que, Jeryl Ritzi T Yu, Ma Socorro C Martinez, Alexandria E Matic, John Angelo Luigi S Perez, Glenn Anthony A Constantino, Aldanica R Olano, Liz Edenberg P Quiles, Artemio A Roxas Jr, 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, Maritzie R Eribal, Ryndell G Alava, Muktader A Kalbi, Nasheera W Radja, Mohammad Elshad S Sali

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.

Keywords: COVID-19; Cohort study; Intensive care unit admission; Mortality; New-onset neurological symptoms; Respiratory failure.

Conflict of interest statement

All authors have stated explicitly that there are no conflicts of interest in connection with this article.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow of patients in the Philippine CORONA study
Fig. 2
Fig. 2
Cumulative hazard by exposure to new-onset neurological symptoms for A mortality, B intensive care unit admission and C respiratory failure

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