Abstract
Objectives
COVID-19 is associated with mortality in those with comorbidities. The aim of this study was to evaluate in-hospital outcomes in patients with COVID-19 with and without epilepsy.
Methods
We conducted a retrospective study of patients with COVID-19 admitted in a multicenter health system between March 15, 2020 and May 17, 2021. Patients with epilepsy were identified using a validated ICD-9-CM/ICD-10-CM case definition. Logistic regression models and Kaplan-Meier analyses were conducted for mortality and non-routine discharges (i.e., not discharged home). An ordinary least squares regression model was fitted for length-of-stay (LOS).
Results
We identified 9,833 people with COVID-19 including 334 with epilepsy. People with epilepsy had significantly higher ventilator use (37.70% vs. 14.30%, p<0.001), ICU admissions (39.20% vs. 17.70%, p<0.001) mortality (29.60% vs 19.90%, p<0.001), longer LOS (12 days vs. 7 days, p<0.001) and fewer were discharged home (29.64% vs. 57.37%, p<0.001) in univariable analysis. In multivariable analysis, only non-routine discharge (aOR, 2.70; 95% CI 2.00-3.70, p<0.001) and LOS (32.50% longer, 95% CI 22.20%-43.60%, p<0.001) were significantly different. Factors associated with higher odds of mortality in epilepsy were older age (aOR, 1.05; 95% CI 1.03-1.08, p<0.001), ventilator support (aOR, 7.18; 95% CI 3.12-16.48, p<0.001) and higher Charlson Comorbidity Index (CCI) (aOR, 1.18; 95% CI 1.04-1.34, p=0.010). In epilepsy, admissions between August-December 2020 or January-May 2021 were associated with lower odds of non-routine discharge and decreased LOS compared to admissions between March-July 2020 but this difference was not statistically significant.
Significance
People with COVID-19 who had epilepsy had higher odds of non-routine discharge and longer LOS but not higher mortality. Older age (>65), ventilator use, and higher CCI were associated with COVID 19 mortality in epilepsy. This suggests that older adults with epilepsy and multimorbidity are more vulnerable than those without and should be closely monitored in the setting of COVID-19.
JUL