Patients with neurological or psychiatric complications of COVID-19 have worse long-term functional outcomes: COVID-CNS-A multicentre case-control study

It is established that patients hospitalised with COVID-19 often have ongoing morbidity affecting activity of daily living (ADL), employment, and mental health. However, little is known about the relative outcomes in patients with COVID-19 neurological or psychiatric complications. We conducted a UK multicentre case-control study of patients hospitalised with COVID-19 (controls) and those who developed COVID-19 associated acute neurological or psychiatric complications (cases). Among the 651 patients, [362 (55%) cases and 289 (45%) controls], a higher proportion of cases had impairment in ADLs (199 [68.9%] vs 101 [51.8%], OR 2.01, p<0.0002) and reported symptoms impacting employment (159 [58.2%] vs 69 [35.6%] OR 2.53, p<0.0001). There was no significant difference in the proportion with depression or anxiety between cases and controls overall. For cases, impairment of ADLs was associated with increased risk in females, age >50 years and hypertension (OR 5.43, p<0.003, 3.11, p=0.02, 3.66, p=0.04). Those receiving either statins or angiotensin converting enzyme inhibitors had a lower risk (OR 0.09, p=0.0006, 0.17, p=0.03). Patients with neurological or psychiatric complications of COVID-19 had worse functional outcomes than those with respiratory COVID-19 alone in terms of ADLs and employment. Female sex, age >50 years, and hypertension were associated with worse outcomes, and statins or ACE inhibitors with better outcomes.