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A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications

Frontera et al., Journal of the Neurological Sciences, doi:10.1016/j.jns.2021.117486
Jul 2021  
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PASC, mRS 33% Improvement Relative Risk PASC, return to work 57% Zinc for COVID-19  Frontera et al.  LATE TREATMENT Is late treatment with zinc beneficial for COVID-19? Prospective study of 382 patients in the USA (Mar - May 2020) Lower PASC with zinc (not stat. sig., p=0.066) c19early.org Frontera et al., J. the Neurological S.., Jul 2021 Favorszinc Favorscontrol 0 0.5 1 1.5 2+
Zinc for COVID-19
2nd treatment shown to reduce risk in July 2020
 
*, now with p = 0.00000032 from 46 studies, recognized in 17 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,800+ studies for 95 treatments. c19early.org
Prospective study of 382 hospitalized COVID-19 patients in New York City, showing significantly worse 6-month functional outcomes, activities of daily living, and return to work with neurological complications during initial hospitalization.
risk of PASC, 32.9% lower, OR 0.67, p = 0.07, mRS, RR approximated with OR.
risk of PASC, 56.5% lower, OR 0.43, p = 0.02, inverted to make OR<1 favor treatment, return to work, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Frontera et al., 31 Jul 2021, prospective, USA, peer-reviewed, median age 68.0, 48 authors, study period 10 March, 2020 - 20 May, 2020. Contact: jennifer.frontera@nyulangone.org.
This PaperZincAll
A prospective study of long-term outcomes among hospitalized COVID-19 patients with and without neurological complications
Jennifer A Frontera, Dixon Yang, Ariane Lewis, Palak Patel, Chaitanya Medicherla, Vito Arena, Taolin Fang, Andres Andino, Thomas Snyder, Maya Madhavan, Daniel Gratch, Benjamin Fuchs, Alexa Dessy, Melanie Canizares, Ruben Jauregui, Betsy Thomas, Kristie Bauman, Anlys Olivera, Dhristie Bhagat, Michael Sonson, George Park, Rebecca Stainman, Brian Sunwoo, Daniel Talmasov, Michael Tamimi, Yingrong Zhu, Jonathan Rosenthal, Levi Dygert, Milan Ristic, Haruki Ishii, Eduard Valdes, Mirza Omari, Lindsey Gurin, Joshua Huang, Barry M Czeisler, D Ethan Kahn, Ting Zhou, Jessica Lin, Aaron S Lord, Kara Melmed, Sharon Meropol, Andrea B Troxel, Eva Petkova, Thomas Wisniewski, Laura Balcer, Chris Morrison, Shadi Yaghi, Steven Galetta
Journal of the Neurological Sciences, doi:10.1016/j.jns.2021.117486
Background: Little is known regarding long-term outcomes of patients hospitalized with COVID-19. Methods: We conducted a prospective study of 6-month outcomes of hospitalized COVID-19 patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 survivors without neurological complications hospitalized during the same period. The primary 6month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety, depression, fatigue and sleep. Results: Of 606 COVID-19 patients with neurological complications, 395 survived hospitalization and were matched to 395 controls; N = 196 neurological patients and N = 186 controls completed follow-up. Overall, 346/ 382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition, 47% could not return to work and 62% scored worse than average on ≥1 Neuro-QoL scale (worse anxiety 46%, sleep 38%, fatigue 36%, and depression 25%). In multivariable analysis, patients with neurological complications had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 1.98, 95%CI 1.23-3.48, P = 0.02), worse ADLs (aOR 0.38, 95%CI 0.29-0.74, P = 0.01) and were less likely to return to work than controls (41% versus 64%, P = 0.04). Cognitive and Neuro-QOL metrics were similar between groups. Conclusions: Abnormalities in functional outcomes, ADLs, anxiety, depression and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19. In multivariable analysis, patients with neurological complications during index hospitalization had significantly worse 6-month functional outcomes than those without.
Appendix A. Supplementary data Supplementary data to this article can be found online at https://doi. org/10.1016/j.jns.2021.117486 .
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Late treatment
is less effective
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