Nikhil Prasad Fact checked by:Thailand Medical News Team Sep 16, 2026 48 minutes ago
Neuropsychiatric symptoms in people hospitalized with COVID-19 may be less an isolated brain problem than part of wider multi-organ illness, according to a Romanian study that found kidney and urinary-system involvement carried greater prognostic weight for intensive care and death.
COVID-19 neurological symptoms often appeared within broader multi-organ disease, while renal-urinary
involvement more strongly predicted ICU admission and death
Researchers analyzed records from 1,361 adults hospitalized with confirmed SARS-CoV-2 infection at Academic Emergency Hospital Sibiu between March 2020 and January 2025. The researchers were from the Infectious Diseases Department at Academic Emergency Hospital Sibiu; Department of Parasitology and Parasitic Diseases at the University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca; AINIMAL SRL; and Faculty of Medicine at Lucian Blaga University of Sibiu, Romania.
A Five-System View of COVID-19
Instead of examining neurological and psychiatric problems alone, investigators mapped five clinical axes: respiratory, cardiovascular, neuropsychiatric, hepato-gastrointestinal, and renal-urinary.
The cohort had a median age of 66, 54.6% were women, 14.1% required intensive care, and 9.4% died in hospital. Multi-organ disease was strikingly common: 91% had involvement in at least two organ axes.
Although 22.9%, or 312 patients, were neuropsychiatric-positive, only 11 patients—0.8% of the cohort—had neuropsychiatric disease classified as the dominant phenotype. Among neuropsychiatric-positive patients, 98.1% had at least one additional chronic organ axis.
Kidney-Related Involvement Stood Out
The clearest prognostic signal came from the renal-urinary axis. After adjustment for the other organ systems, renal-urinary involvement was associated with nearly twice the odds of ICU admission (OR 1.97, 95% CI 1.41–2.74) and more than 2.5 times the odds of in-hospital death (OR 2.58, 95% CI 1.72–3.93).
Broad neuropsychiatric positivity, by comparison, was not independently associated with either outcome. Its adjusted odds ratio was 1.39 for ICU admission and 1.33 for death, neither statistically significant. Cardiovascular involvement showed a strong but separation-sensitive relationship with death because 127 of 128 patients who died were cardiovascular-positive.
Laboratory Clues Shrink After Tougher Testing
The analysis also challenged the assumption that laboratory abnormalities accompanying neurological or psychiatric symptoms necessarily indicate brain-specific COVID-19 biology.
Of 169 laboratory and microbiology comparisons screened for the neuropsychiatric axis, 42 initially passed the false-discovery-rate threshold. After researchers accounted for other organ involvement and clinical factors, only three electrolyte associations remained: mean chloride, maximum chloride, and maximum sodium.
Researchers interpreted these findings as renal-metabolic or electrolyte co-associations rather than standalone neuropsychiatric biomarkers. Other promising signals, including inflammatory, coagulation, microbiological, renal, and imagin
g findings, largely lost neuropsychiatric specificity after stricter controls.
One Neurological Signal Survived
One result remained distinctive. Severe neurological presentations became substantially more common during the Late Omicron period. The age- and sex-adjusted odds ratio was 3.35 compared with the early pandemic, and the association remained virtually unchanged after additional adjustment for four other organ axes. It was the only one of 35 prespecified claims ultimately retained as neuropsychiatric-specific.
For this
Thailand Medical News report, the key message is not that neurological or psychiatric complications are unimportant. Instead, the findings suggest they frequently occur within a broader pattern of systemic disease, making kidney function, electrolytes, cardiovascular conditions, treatments, and other organ involvement important when interpreting neurological findings.
Conclusions
The study suggests neuropsychiatric involvement in hospitalized COVID-19 is common but rarely represents the dominant clinical problem. Renal-urinary disease showed the most consistent independent relationship with both ICU admission and mortality, while most apparent neuropsychiatric laboratory signals weakened after rigorous adjustment. However, the single-center retrospective design, reliance on routine clinical documentation, potential misclassification, missing variables, and limited generalizability mean prospective multicenter studies with standardized neurological assessments are needed to confirm these findings.
The study findings were published in the peer reviewed journal: Pathogens.
https://www.mdpi.com/2076-0817/15/9/979
Read Also:
https://www.thailandmedical.news/articles/coronavirus
https://www.thailandmedical.news/articles/long-covid 
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