Among patients with stroke, outcomes worse in those with COVID-19
Ischemic stroke in patients with COVID-19 conferred greater mortality and worse functional outcomes than stroke in patients without COVID-19, according to a report published in Stroke.
“The association between COVID-19 and severe stroke highlights the urgent need for studies aiming to uncover the underlying mechanisms and is relevant for prehospital stroke awareness and in-hospital acute stroke pathways during the current and future pandemics, since severe strokes have typically poor prognosis and can potentially be treated with recanalization techniques,” George Ntaios, MD, MSc, PhD, from the department of internal medicine of the School of Health Sciences at the University of Thessaly in Larissa, Greece, and colleagues wrote.
For this analysis, researchers pooled consecutive patients hospitalized with COVID-19 and stroke from 28 sites in 16 countries (n = 174; median age, 71 years; 38% women) and performed a 1-to-1 propensity score matching analyses with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne project from 2003 to 2019.
Researchers observed that the median NIH Stroke Scale score was higher in patients with COVID-19 (OR = 1.69; 95% CI, 1.08-2.65) compared with patients without COVID-19. There was no difference between the populations in prevalence of large-artery stroke compared with lacunar stroke (P = .082), according to the researchers.
Among survivors with available information about disability status, 51% had severe disability at hospital discharge, according to the report. In addition, 27.6% of patients died, approximately half each from stroke and COVID-19.
“Our study confirmed this finding in a large international multicenter cohort and showed that the outcomes of these patients are poorer compared with non-COVID-19 ischemic stroke patients,” Ntaios told Healio. “It is not yet clear whether SARS-CoV-2 exerts some direct prothrombotic (eg, via platelet activation or infection-induced arrhythmias) or vasculopathic effect, or it is just the added comorbidity that worsens the presentation and outcomes of these patients.”
Moreover, patients with COVID-19 had greater risk for severe disability (median modified Rankin Scale score, 4 vs. 2; P < .001) and mortality (OR = 4.3; 95% CI, 2.22-8.3) compared with patients with stroke and non-COVID-19.
“There are several potential explanations for the relation between COVID-19-associated ischemic strokes and increased stroke severity, which may coexist,” the researchers wrote. “It was proposed that viral infections may cause a direct vasculopathic effect (endotheliopathy) or potentiate the prothrombotic milieu via several mechanisms including immune-mediated platelet activation, dehydration and infection-induced cardiac arrhythmias. It is unclear whether the finding of increased severity in COVID-19 associated ischemic strokes applies to all ischemic stroke types or is mainly driven by an increase in large-vessel occlusion strokes, as implied by recent findings.”
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.