Neurological involvement in Coronavirus disease-2019 (COVID-19) is widely recognized. However, the role of pre-existing neurological comorbidities in modulating COVID-19-related mortality still remains unclear. This cohort study evaluates the COVID-19-related case fatality rate (CFR) of patients with pre-existing neurological diseases. The authors retrospectively evaluated all patients consecutively admitted to their hospital with a diagnosis of COVID-19 between March and April 2020. A multivariate regression analysis was used to estimate the association between pre-existing neurological diseases and COVID-19-related mortality. Then, the authors compared the CFR and survival curves of two cohorts (patients suffering vs. those not suffering from pre-existing neurological disease), matched trough the propensity score (PS). Age and other comorbidities were considered for PS calculation. A
1:1 matching for the entire neurological cohort was applied and, separately, for cerebrovascular, neurodegenerative, and other neurological diseases. Among 332 patients, 75 (22.6%) were affected by pre-existing neurological disease (n = 29 cerebrovascular, n = 26 neurodegenerative, n = 20 others). From the multivariate regression analysis, they resulted with a significant increase of COVID-19-related mortality (OR:2.559; 95%CI 1.181-5.545; p < 0.017). From the cohort analysis, CFR resulted 2-fold higher in patients with neurological disease (48.0% vs. 24.0%; p = 0.002). CFR was significantly higher in patients with neurodegenerative diseases compared to matched individuals (73.9% vs. 39.1%; p = 0.017), while CFR increase in patients with cerebrovascular diseases did not reach statistical significance (48.3% vs. 41.4%; p = 0.597). The authors concluded that pre-existing neurological comorbidities, in particular neurodegenerative diseases, increase significantly COVID-19-related case fatality, indicating a clear priority for viral screening, access to care facilities and vaccination in these populations.
Romagnolo A, Imbalzano G, Artusi CA, Balestrino R, Ledda C, De Rosa FG, Riccardini F, Montanaro E, Bozzali M, Rizzone MG, Zibetti M, Lopiano L. Neurological comorbidities and COVID-19-related case fatality: A cohort study. J Neurol Sci. 2021 Aug 5;428:117610. Doi: 10.1016/j.jns.2021.117610.