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.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/outcome-and-mortality-of-hospital-admission-with-covid-19-in-parkinsonian-syndromes/