Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States

Havenon, Adam de; Ney, John P.; Callaghan, Brian C.; Delic, Alen; Hohmann, Samuel F.; Shippey, Ernie; Esper, Gregory J.; Stulberg, Eric; Tirschwell, David; Frontera, Jennifer A.; Yaghi, Shadi; Anadani, Mohammad; Majersik, Jennifer J.

doi:10.1016/j.jstrokecerebrovasdis.2020.105535

Cited by 31 publications

(29 citation statements)

References 26 publications

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“…We confirmed an increased mortality with higher rate of respiratory and thrombotic complications and markedly abnormal blood test among COVID-19 patients. We found lower rate of IVT or EVT in this population, confirming the results of a previous work [ 11 ]. It must be noted however that others [ 12 , 13 ] have not reported this difference.…”

Section: Discussionsupporting

confidence: 92%

In-hospital and out-of-hospital stroke in patients with COVID-19: two different diseases?

et al. 2022

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Background Ischemic stroke is a known complication of COVID-19. It may have a different pathogenesis and worse outcome compared to stroke in patients without COVID-19. Furthermore, patients with COVID-19 and out-of-hospital stroke onset might have different characteristics compared to patients with COVID-19 and in-hospital stroke onset. The aim of our study was to analyze the characteristics of patients with stroke with and without COVID-19 and of patients with COVID-19 with in-hospital and out-of-hospital stroke. Methods We performed a retrospective study of all consecutive patients admitted to our hospital with ischemic stroke between October 2020 and February 2021. We compared functional outcome, lab test, demographic, and clinical characteristics between patients with or without COVID-19. We performed a sub-analysis comparing patients with COVID-19 and in-hospital and out-of-hospital stroke onset. Results We included in the final analysis 137 patients of whom 26 with COVID-19. Half (13) had out-of-hospital stroke and half in-hospital stroke onset. Overall, patients with COVID-19 had higher mortality compared to the control group (27% vs 9%, p : 0.02), and non-significantly lower rate of good functional outcome (50% vs 63%, p : 0.22). Patients with COVID-19 and out-of-hospital stroke had higher rate of good functional outcome (69% vs 39%, p : 0.05), higher lymphocyte count, and lower D-dimer compared with patients with in-hospital stroke onset. Conclusions Patients with stroke and COVID-19 had higher mortality compared to patients without COVID-19. Among patients with COVID-19 those with out-of-hospital stroke had better outcome and fewer blood test abnormalities compared to patients with in-hospital stroke. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05807-w.

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Section: Discussionsupporting

confidence: 92%

In-hospital and out-of-hospital stroke in patients with COVID-19: two different diseases?

et al. 2022

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“…Risk factors for stroke in COVID + patients included disease severity and ischemic heart disease [ 32 ]. Along with cerebral infarction, intracerebral and subarachnoid haemorrhage were more frequently documented among hospitalized COVID-19 + than in COVID-19 negative subjects [ 50 ]. Disease severity was higher in older than in younger cohorts, with 32.1% (85/265) in-hospital mortality and 36.4% (96/265) institutionalization rate in the oldest elderly subjects who had a stroke during the course of their COVID-19 infection [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions

et al. 2021

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Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10848-4.

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“…We included race/ethnicity as a variable of interest in the study based on a previous study indicating racial/ethnic disparities among patients with COVID-19. 16 …”

Section: Methodsmentioning

confidence: 99%

“… 6 , 7 , 8 Although the burden of COVID-19 increased in the US, 9 additional data on rates of IS through the end of 2020 have not been published, to our knowledge. Previous research has suggested that patients with IS and comorbid COVID-19 have poor outcomes 10 , 11 , 12 , 13 , 14 , 15 , 16 ; however, to our knowledge, that research has not explored the impact of IS being identified at hospital admission vs during hospitalization with COVID-19. 2 , 17 This study used a data set from 478 hospitals throughout the US to examine the clinical characteristics and outcomes among 5517 patients with IS and COVID-19 who were discharged in 2020 compared with those of patients with IS who were discharged in 2019.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic

et al. 2021

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IMPORTANCE After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. OBJECTIVE To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. EXPOSURE Ischemic stroke and laboratory-confirmed COVID-19. MAIN OUTCOMES AND MEASURES Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. RESULTS Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged Ն80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged Ն80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged Ն80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554)discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or (continued)

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Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States

Cited by 31 publications

References 26 publications

In-hospital and out-of-hospital stroke in patients with COVID-19: two different diseases?

In-hospital and out-of-hospital stroke in patients with COVID-19: two different diseases?

Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions

Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic

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