Epilepsy was associated with higher in-hospital mortality, longer length of stay, and worse discharge dispositions among older adults with COVID-19.

Older adults with comorbid epilepsy and COVID-19 infection demonstrated poorer outcomes compared to individuals without epilepsy. This suggests that pre-existing neurologic conditions, such as epilepsy, may be risk factors for worse COVID-19 outcomes among older adults. These are the findings of a study published in the journal Seizure.

Researchers in New York conducted a retrospective, multicenter, cohort study of 5384 patients aged 65 and older — 173 (3.21%) with and the remaining 5211 without epilepsy — admitted to the hospital with COVID-19 infection between March 2020 and May 2021. They sought to examine how existing neurologic conditions impacted the course of COVID-19 infection, including mortality, among adults aged 65 and older.

Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.

Compared to individuals without epilepsy, the average age of those with epilepsy and COVID-19 infection was much younger (75.44 vs 77.98 years). Not only were patients with epilepsy younger, but after adjusting for age and other comorbidities, they also demonstrated the following hospital outcomes compared to those without epilepsy:

  • increased likelihood of receiving mechanical ventilation (35.84% vs 16.18)
  • decreased likelihood of being discharged home (21.39% vs 43.12% with an adjusted odds ratio [aOR] of 3.34; 95% CI, 2.21-5.03)
  • increased median length of hospital stay (13 days vs 8 days with a 46.46% longer length of stay than those without epilepsy; 95% CI, 34%-59%)
  • increased in-hospital mortality (35.84% vs 28.29% with an aOR of 1.55; 95% CI, 1.12-2.14)

“[E]pilepsy was still associated with higher in-hospital mortality, longer LOS [length of stay] and worse discharge dispositions in older adults with COVID-19,” the researchers concluded. “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.”

Study limitations included potential residual confounding variables introducing bias into the results, use of ICD-10 codes to determine epilepsy diagnosis allowing for possible misclassification or coding errors, and lack of generalizability to populations outside of the multi-hospital system in New York.

Additionally, the dataset did not include complete information about epilepsy type, severity, etiology, treatment, or dosing for each participant. Also, information was lacking on the location from which each participant was admitted, including nursing homes, which may have influenced discharge location.

 

Source: neurologyadvisor.com, Maria Arini Lopez

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