7 april 2021: Bron: The Lancet psychiatry

Maar liefst een op de drie mensen die met het coronavirus -  Covid-19 zijn geïnfecteerd geweest, heeft op langere termijn last van psychische of neurologische klachten. 34 procent van de ruim 236.000 onderzochte patiënten kreeg binnen een half jaar een diagnose van neurologische- of psychiatrische aard.

De meest voorkomende diagnose was angst, aangetroffen bij 17% van degenen die werden behandeld voor Covid-19, gevolgd door stemmingsstoornissen, aangetroffen bij 14% van de patiënten. Dit melden onderzoekers in een Amerikaanse studie gepubliceerd in The Lancet Psychiatry.
En hoewel de neurologische effecten ernstiger zijn bij eerder in het ziekenhuis opgenomen patiënten, komen ze ook veel voor bij degenen die alleen poliklinisch werden behandeld, aldus de onderzoekers.

"Dat percentage nam geleidelijk toe naarmate de ernst van de Covid-19 ziekte toenam. Als we kijken naar patiënten die in het ziekenhuis werden opgenomen, nam dat percentage toe tot 39%", zegt Maxime Taquet MD, co-auteur van de nieuwe studie.

"Onze resultaten geven aan dat hersenziekten en psychiatrische stoornissen vaker voorkomen na Covid-19 dan na griep of andere luchtweginfecties, zelfs wanneer patiënten worden gematcht voor andere risicofactoren. We moeten nu zien wat er na zes maanden gebeurt", voegde Taquet eraan toe.

Het is de grootste studie op dit gebied tot nu toe en betrof de elektronische medische dossiers van meer dan 236.000 Covid-19 patiënten, voornamelijk in de VS. De onderzoekers vergeleken hun gegevens met degenen die in hetzelfde tijdsbestek andere luchtweginfecties hebben gehad.

De onderzoekers schrijven dat degenen met Covid-19 een 44% verhoogd risico hadden op neurologische en psychiatrische aandoeningen in vergelijking met mensen die herstellende waren van griep. En ze hadden 16% meer kans om die effecten te ervaren in vergelijking met mensen met andere luchtweginfecties.
Ongeveer één op de 50 Covid-19 patiënten had een ischemische beroerte, een bloedstolsel dat de hersenen aantast.

De studie heeft wel een aantal nadelen, zoals de onderzokers ook zelf aangeven, want in Amerika is de gezondheidszorg heel anders ingericht dan in Europa bv en mensen kunnen ook door andere oorzaken neurologische of psychiatrische klachten hebben gekrgen. Maar lees dat in het studieverslag in The Lancet dat volledig en gratis in in te zien of te downloaden.

6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records

Open AccessPublished:April 06, 2021DOI:https://doi.org/10.1016/S2215-0366(21)00084-5


Background

Neurological and psychiatric sequelae of COVID-19 have been reported, but more data are needed to adequately assess the effects of COVID-19 on brain health. We aimed to provide robust estimates of incidence rates and relative risks of neurological and psychiatric diagnoses in patients in the 6 months following a COVID-19 diagnosis.

Methods

For this retrospective cohort study and time-to-event analysis, we used data obtained from the TriNetX electronic health records network (with over 81 million patients). Our primary cohort comprised patients who had a COVID-19 diagnosis; one matched control cohort included patients diagnosed with influenza, and the other matched control cohort included patients diagnosed with any respiratory tract infection including influenza in the same period. Patients with a diagnosis of COVID-19 or a positive test for SARS-CoV-2 were excluded from the control cohorts. All cohorts included patients older than 10 years who had an index event on or after Jan 20, 2020, and who were still alive on Dec 13, 2020. We estimated the incidence of 14 neurological and psychiatric outcomes in the 6 months after a confirmed diagnosis of COVID-19: intracranial haemorrhage; ischaemic stroke; parkinsonism; Guillain-Barré syndrome; nerve, nerve root, and plexus disorders; myoneural junction and muscle disease; encephalitis; dementia; psychotic, mood, and anxiety disorders (grouped and separately); substance use disorder; and insomnia. Using a Cox model, we compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory tract infections. We investigated how these estimates were affected by COVID-19 severity, as proxied by hospitalisation, intensive therapy unit (ITU) admission, and encephalopathy (delirium and related disorders). We assessed the robustness of the differences in outcomes between cohorts by repeating the analysis in different scenarios. To provide benchmarking for the incidence and risk of neurological and psychiatric sequelae, we compared our primary cohort with four cohorts of patients diagnosed in the same period with additional index events: skin infection, urolithiasis, fracture of a large bone, and pulmonary embolism.

Findings

Among 236 379 patients diagnosed with COVID-19, the estimated incidence of a neurological or psychiatric diagnosis in the following 6 months was 33·62% (95% CI 33·17–34·07), with 12·84% (12·36–13·33) receiving their first such diagnosis. For patients who had been admitted to an ITU, the estimated incidence of a diagnosis was 46·42% (44·78–48·09) and for a first diagnosis was 25·79% (23·50–28·25). Regarding individual diagnoses of the study outcomes, the whole COVID-19 cohort had estimated incidences of 0·56% (0·50–0·63) for intracranial haemorrhage, 2·10% (1·97–2·23) for ischaemic stroke, 0·11% (0·08–0·14) for parkinsonism, 0·67% (0·59–0·75) for dementia, 17·39% (17·04–17·74) for anxiety disorder, and 1·40% (1·30–1·51) for psychotic disorder, among others. In the group with ITU admission, estimated incidences were 2·66% (2·24–3·16) for intracranial haemorrhage, 6·92% (6·17–7·76) for ischaemic stroke, 0·26% (0·15–0·45) for parkinsonism, 1·74% (1·31–2·30) for dementia, 19·15% (17·90–20·48) for anxiety disorder, and 2·77% (2·31–3·33) for psychotic disorder. Most diagnostic categories were more common in patients who had COVID-19 than in those who had influenza (hazard ratio 1·44, 95% CI 1·40–1·47, for any diagnosis; 1·78, 1·68–1·89, for any first diagnosis) and those who had other respiratory tract infections (1·16, 1·14–1·17, for any diagnosis; 1·32, 1·27–1·36, for any first diagnosis). As with incidences, HRs were higher in patients who had more severe COVID-19 (eg, those admitted to ITU compared with those who were not: 1·58, 1·50–1·67, for any diagnosis; 2·87, 2·45–3·35, for any first diagnosis). Results were robust to various sensitivity analyses and benchmarking against the four additional index health events.

Interpretation

Our study provides evidence for substantial neurological and psychiatric morbidity in the 6 months after COVID-19 infection. Risks were greatest in, but not limited to, patients who had severe COVID-19. This information could help in service planning and identification of research priorities. Complementary study designs, including prospective cohorts, are needed to corroborate and explain these findings.

Funding

National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre.
Research in context
Evidence before this study
We searched Web of Science and Medline on Aug 1 and Dec 31, 2020, for studies in English, with the terms “(COVID-19 OR SARS-CoV2 OR SARS-CoV-2) AND (psychiatri* or neurologi*) AND (incidence OR epidemiologi* OR ‘systematic review’ or ‘meta-analysis’)”. We found case series and reviews of series reporting neurological and neuropsychiatric disorders during acute COVID-19 illness. We found one large electronic health records study of the psychiatric sequelae in the 3 months after a COVID-19 diagnosis. It reported an increased risk for anxiety and mood disorders and dementia after COVID-19 compared with a range of other health events; the study also reported the incidence of each disorder. We are not aware of any large-scale data regarding the incidence or relative risks of neurological diagnoses in patients who had recovered from COVID-19.
Added value of this study
To our knowledge, we provide the first meaningful estimates of the risks of major neurological and psychiatric conditions in the 6 months after a COVID-19 diagnosis, using the electronic health records of over 236 000 patients with COVID-19. We report their incidence and hazard ratios compared with patients who had had influenza or other respiratory tract infections. We show that both incidence and hazard ratios were greater in patients who required hospitalisation or admission to the intensive therapy unit (ITU), and in those who had encephalopathy (delirium and other altered mental states) during the illness compared with those who did not.
Implications of all the available evidence
COVID-19 was robustly associated with an increased risk of neurological and psychiatric disorders in the 6 months after a diagnosis. Given the size of the pandemic and the chronicity of many of the diagnoses and their consequences (eg, dementia, stroke, and intracranial haemorrhage), substantial effects on health and social care systems are likely to occur. Our data provide important evidence indicating the scale and nature of services that might be required. The findings also highlight the need for enhanced neurological follow-up of patients who were admitted to ITU or had encephalopathy during their COVID-19 illness.

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