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Outcome and mortality of hospital admission with COVID-19 in parkinsonian syndromes

L. Sorrell, A. Barnett, A. King, J. Inches, J. Rideout, J. Sneyd, C. Kobylecki, K. Chaudhuri, R. Walker, H. Martin, K. Stevens, S. Campbell, C. Carroll (Plymouth, United Kingdom)

Meeting: 2022 International Congress

Abstract Number: 1164

Keywords: Parkinson’s

Category: Parkinsonism, Others

Objective: To evaluate features associated with poor outcome and mortality of COVID-19 in people with Parkinson’s disease (PD) and atypical Parkinsonian syndromes (APS) in a hospital setting.

Background: Previous studies have demonstrated increased mortality of COVID-19 in people with PD. It is not known whether this is associated with disease-related factors (eg autonomic dysfunction, dysphagia).

Method: We used an online survey tool to capture anonymised patient data from hospital admission records of people with PD and APS who tested positive (PCR) for COVID-19 between February ‘20 and July ‘21. We used Cox proportional hazards and linear regression models to evaluate characteristics associated with mortality, increased care requirement and more severe COVID-19 infection. Models were adjusted for known associations with poor outcome, such as co-morbidities, age and sex.

Results: Data were collected from 556 admissions from 21 UK sites: 352 (63%) PD; 171 (31%) PD dementia; 33 (6%) APS; 66.2% male; median (IQR) age 80 (11) years; median disease duration 5 (7) years. 19.2% were asymptomatic, 28.8% had mild respiratory symptoms, 52.5% required respiratory support and 35.8% had delirium. Existence of a co-morbid chronic neurological disorder was associated with increased risk of requiring respiratory support (OR 1.83 (95% CI 1.07,3.12)). 38.3% died within 28 days of a positive COVID-19 test. 33.0% of discharged individuals required an increase in care post-admission. Multivariable analysis revealed increased 28-day mortality risk with male sex (HR 1.79 (1.28,2.5)), pre-morbid severe frailty (HR 1.7 (1.22,2.37)), dementia (HR 1.67 (1.19,2.35)), requirement for respiratory support related to COVID-19 infection (HR 3.75 (2.33,5.56)) and pre-morbid respiratory compromise (HR 2.81 (1.12,7.05)), and reduced 28-day mortality risk with vaccination (HR 0.34 (0.12,0.92)). We found no association of mortality with other PD-related factors in multivariable analyses; however, some association is suggested in univariable analyses with marked motor fluctuations (HR 1.39 (1.03,1.87)), significant cognitive impairment/psychosis (HR 1.87 (1.41,1.98) and bulbar symptoms (HR 1.42 (1.02,1.98)).

Conclusion: Identification of Parkinson’s-related and other features associated with poor in-hospital COVID-19 outcome will allow more informed discussion relating to individual COVID-19 risk.

To cite this abstract in AMA style:

L. Sorrell, A. Barnett, A. King, J. Inches, J. Rideout, J. Sneyd, C. Kobylecki, K. Chaudhuri, R. Walker, H. Martin, K. Stevens, S. Campbell, C. Carroll. Outcome and mortality of hospital admission with COVID-19 in parkinsonian syndromes [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/outcome-and-mortality-of-hospital-admission-with-covid-19-in-parkinsonian-syndromes/. Accessed September 22, 2023.
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