Clinical characteristics, hospital course, and outcomes among COVID-19 positive patients with mental illness in a community hospital in New York City

Abstract

Background: Emerging evidence suggests a definite neuropsychiatric sequela of the SARS-CoV-2 infection possibly from a direct effect of the virus on the central nervous system. Although the pathophysiology of the virus and the epidemiology of its impact are only just being unraveled, clinical characteristics, and outcomes specifically among patients with primary psychiatric disorders who are hospitalized with COVID-19 remain unclear and unreported. Methods: This is a retrospective cohort study of all patients with psychiatric diagnoses who were hospitalized patients with severe SARS-CoV-2 infection in a community hospital in New York City. Results: More than 80% of the cohort are African Americans. Hypertension (61.2%), morbid obesity (41.8%) and diabetes (27.6%) were the most prevalent co-morbid medical conditions. Schizophrenia (32.7%) and Major Depressive disorder (29.6%) were the most common psychiatric diagnoses reported. At triage, the most common presentations were fever (57.1%), cough (55.1%), myalgia (32.7%), fatigue (25.5%), and altered mental status (19.4%). Distinctly high infection-related inflammatory markers and cytokines were also reported with median values including CRP (85.5 mg/ml), D-dimer (2061 ng/ml), procalcitonin (1.1 ng/ml) and IL-6 (65.5 pg/ml). Conclusion: Results from this study strengthen preliminary data that show an overrepresented COVID-19 burden in the African American community. This further suggests that the same holds true among a cohort of patients with psychiatric conditions hospitalized with severe COVID-19 infection. Having comorbid mental illness and older age were observed as independent factors of morbidity and mortality. The finding of elevated inflammatory markers in this cohort may account for the prolonged hospitalization and hospital course, morbidity and mortality among COVID patients with comorbid psychiatric diagnoses and requires further investigation.