COVID-19 Resource Center
COVID-19 Resource Center
Source/Disclosures
Disclosures: Merkler reports he received personal fees for medicolegal consulting on stroke. Please see the study for all other authors’ relevant financial disclosures.
July 09, 2020
2 min read
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Stroke risk higher in COVID-19 vs. influenza

Source/Disclosures
Disclosures: Merkler reports he received personal fees for medicolegal consulting on stroke. Please see the study for all other authors’ relevant financial disclosures.
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Patients who visited the ED or were hospitalized for COVID-19 had a higher risk for ischemic stroke compared with those with ED visits or hospitalizations for influenza, researchers found.

“We found that COVID-19 was associated with a far greater risk for stroke than the flu and stress the importance of combating this deadly disease,” Alexander E. Merkler, MD, assistant professor of neurology and neuroscience at Weill Cornell Medicine, told Healio. “Our findings highlight the fact that COVID is not the same as the flu. COVID is far more serious, as we found that COVID is associated with an almost eightfold higher risk for stroke than the flu.”

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In this retrospective cohort study published in JAMA Neurology, researchers analyzed data from 1,916 patients who visited the ED or were hospitalized for COVID-19 between March 4 and May 2. This group was compared with 1,486 patients who visited the ED or were hospitalized for influenza between January 2016 and May 2018.

Alexander E. Merkler

“Prior studies on the risk for stroke in COVID were limited to single-case reports or case series, which means they lacked a comparison group,” Merkler said in an interview. “Our study directly compares the risk for stroke in patients with COVID to the risk for stroke in patients with the flu. By doing so, we were able to obtain a sense of how serious COVID is, at least with regard to the risk for neurological injury as compared to a known disease entity, the flu.”

The primary outcome was acute ischemic stroke.

Of the patients with COVID-19, 1.6% (n = 31; median age, 69 years; 58% men) had acute ischemic stroke (95% CI, 1.1-2.3). Of those with COVID-19 and stroke, the presenting complaint for 26% of patients was stroke. In contrast, acute ischemic stroke occurred in 0.2% of patients with influenza (95% CI, 0-0.6).

The COVID-19 group was more likely to have an acute ischemic stroke vs. the influenza group after adjusting for sex, age and race (OR = 7.6; 95% CI, 2.3-25.2). The link between COVID-19 and acute ischemic stroke persisted in several sensitivity analyses that adjusted for viral symptomatology, vascular risk factors and ICU admissions.

“Patients should seek emergency care if they develop or think they are developing signs of stroke, whether or not they think they have COVID,” Merkler told Healio. “Physicians should be aware that COVID increases the risk for stroke and that efforts should be made to provide timely stroke treatments in order to help reduce the chance of permanent brain injury.”

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For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio.

For more information:

Alexander E. Merkler, MD, can be reached at alm9097@med.cornell.edu.