Severe COVID-19 outcomes in patients with epilepsy: evidence from a nationwide, population-based study in Poland

OBJECTIVE: The course of COVID-19 and its mortality rate largely depend on the presence of comorbidities. The aim of the study was to evaluate the association between epilepsy and severe COVID-19 outcomes in a nationwide cohort of hospitalized patients in Poland. METHODS: This retrospective, nationwide, population-based cohort study used National Health Fund data to identify adults hospitalized due to COVID-19 between 1 March 2021 and 31 December 2023. Patients with epilepsy were identified based on neurologist-confirmed diagnosis and antiseizure medication use. Exact matching was applied to ensure comparability between people with epilepsy (PWE) and patients without epilepsy (PWOE). Outcomes included 60-day mortality, intensive care unit (ICU) admission, mechanical ventilation, and length of hospital stay (LOS). RESULTS: A total of 404,639 COVID-19 hospitalizations were analyzed, including 3,362 PWE in the unmatched cohort. After matching, epilepsy was associated with a significantly higher risk of death within 60 days of admission, with odds of death 26.4% higher among PWE compared with PWOE. LOS was also significantly longer in PWE, by approximately 14.6%. Epilepsy was not independently associated with an increased risk of mechanical ventilation or ICU admission. CONCLUSIONS: In this large nationwide cohort, epilepsy was associated with increased mortality and prolonged hospitalization among patients hospitalized with COVID-19 in Poland, although it did not independently increase the likelihood of ICU admission or mechanical ventilation. These findings suggest that PWE - particularly those with substantial comorbidity burden - represent a clinically vulnerable population in the context of COVID-19 and may require heightened clinical attention and preventive strategies.