tetano
Editor, Senior Moderator
Seizure
. 2023 Nov 26:114:33-39.
doi: 10.1016/j.seizure.2023.11.018. Online ahead of print. Older adults with epilepsy and COVID-19: Outcomes in a multi-hospital health system
Claire Ufongene[SUP] 1 [/SUP], Grace Van Hyfte[SUP] 2 [/SUP], Parul Agarwal[SUP] 2 [/SUP], Jonathan Goldstein[SUP] 1 [/SUP], Brian Mathew[SUP] 3 [/SUP], Allison Navis[SUP] 3 [/SUP], Louise McCarthy[SUP] 3 [/SUP], Churl-Su Kwon[SUP] 4 [/SUP], Kapil Gururangan[SUP] 3 [/SUP], Priti Balchandani[SUP] 5 [/SUP], Lara Marcuse[SUP] 3 [/SUP], Georges Naasan[SUP] 3 [/SUP], Anuradha Singh[SUP] 3 [/SUP], James Young[SUP] 3 [/SUP], Alexander Charney[SUP] 6 [/SUP], Girish Nadkarni[SUP] 7 [/SUP], Nathalie Jette[SUP] 8 [/SUP], Leah J Blank[SUP] 9 [/SUP]; Sinai NeuroCOVID-19 Study Group
Affiliations
Background: Coronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy.
Methods: This retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS).
Results: We identified 5384 older adults admitted with COVID-19 of whom 173 (3.21 %) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p = 0.007). Older adults with epilepsy were more likely to be ventilated (35.84 % vs. 16.18 %, p < 0.001), less likely to be discharged home (21.39 % vs. 43.12 %, p < 0.001), had longer median LOS (13 days vs. 8 days, p < 0.001), and had higher in-hospital death (35.84 % vs. 28.29 %, p = 0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95 % CI 1.12-2.14, p = 0.032), non-routine discharge disposition (aOR, 3.34; 95 % CI 2.21-5.03, p < 0.001), and longer LOS (46.46 % 95 % CI 34 %-59 %, p < 0.001).
Conclusions: In models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.
Keywords: Comorbidity; Hospitalization; Mortality; SARS-CoV-2; Seizure.
. 2023 Nov 26:114:33-39.
doi: 10.1016/j.seizure.2023.11.018. Online ahead of print. Older adults with epilepsy and COVID-19: Outcomes in a multi-hospital health system
Claire Ufongene[SUP] 1 [/SUP], Grace Van Hyfte[SUP] 2 [/SUP], Parul Agarwal[SUP] 2 [/SUP], Jonathan Goldstein[SUP] 1 [/SUP], Brian Mathew[SUP] 3 [/SUP], Allison Navis[SUP] 3 [/SUP], Louise McCarthy[SUP] 3 [/SUP], Churl-Su Kwon[SUP] 4 [/SUP], Kapil Gururangan[SUP] 3 [/SUP], Priti Balchandani[SUP] 5 [/SUP], Lara Marcuse[SUP] 3 [/SUP], Georges Naasan[SUP] 3 [/SUP], Anuradha Singh[SUP] 3 [/SUP], James Young[SUP] 3 [/SUP], Alexander Charney[SUP] 6 [/SUP], Girish Nadkarni[SUP] 7 [/SUP], Nathalie Jette[SUP] 8 [/SUP], Leah J Blank[SUP] 9 [/SUP]; Sinai NeuroCOVID-19 Study Group
Affiliations
- PMID: 38039805
- DOI: 10.1016/j.seizure.2023.11.018
Background: Coronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy.
Methods: This retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS).
Results: We identified 5384 older adults admitted with COVID-19 of whom 173 (3.21 %) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p = 0.007). Older adults with epilepsy were more likely to be ventilated (35.84 % vs. 16.18 %, p < 0.001), less likely to be discharged home (21.39 % vs. 43.12 %, p < 0.001), had longer median LOS (13 days vs. 8 days, p < 0.001), and had higher in-hospital death (35.84 % vs. 28.29 %, p = 0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95 % CI 1.12-2.14, p = 0.032), non-routine discharge disposition (aOR, 3.34; 95 % CI 2.21-5.03, p < 0.001), and longer LOS (46.46 % 95 % CI 34 %-59 %, p < 0.001).
Conclusions: In models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.
Keywords: Comorbidity; Hospitalization; Mortality; SARS-CoV-2; Seizure.