Clinical Outcome of Acute Ischemic Strokes in Patients with COVID-19

Abstract

<b><i>Introduction:</i></b> Acute ischemic stroke (AIS) and thrombotic events (TEs) were reported in patients with COVID-19. Clinical outcome of AIS in the course of COVID-19 remains unknown. We compared early clinical outcome and mortality of COVID-positive (+) patients admitted for AIS with COVID-negative (−) ones. We hypothesized that COVID+ patients would have poorer clinical outcomes and present a higher rate of TEs and mortality compared with COVID− ones. <b><i>Methods:</i></b> In this multicentric observational retrospective study, we enrolled patients over 18 years old admitted for AIS in 3 stroke units of the Parisian region during lockdown from March 17, 2020, to May 2, 2020. COVID-19 status as well as demographic, clinical, biological, and imaging data was collected retrospectively from medical records. Poor outcome was defined as modified Rankin score (mRS) 3–6 (3–6) at discharge. We also compared TE frequency and mortality rate through a composite criterion in both groups. <b><i>Results:</i></b> Two hundred and sixteen patients were enrolled; mean age was 68 years old, and 63% were male. Forty patients were CO­VID+ (18.5%) and 176 were COVID−. Obesity was statistically more frequent in the COVID+ group (36 vs. 13% <i>p</i> < 0.01). The percentage of patients with mRS (3–6) at discharge was higher in the COVID+ group compared with the COVID− group (60 vs. 41%, <i>p</i> = 0.034). The main predictor of presenting a mRS (3–6) at discharge was high NIHSS score at admission (OR, CI 95%: 1.325, 1.22–1.43). Mortality rate was higher in the COVID+ group (12 vs. 3.4%, <i>p</i> = 0.033) as well as TE frequency (15 vs. 2.8%, <i>p</i> < 0.01). <b><i>Conclusion:</i></b> In this study, patients with AIS infected by SARS-CoV-2 showed a poorer early outcome than COVID− ones. However, when compared to other factors, COVID-19 was not a significant predictor of poor outcome. Vascular morbidity and mortality rates were significantly higher in the COVID+ group compared with the COVID− group.

Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

“…We observed twice higher inhospital and 3-month mortality in patients hospitalized for stroke with a primary diagnosis of COVID-19 (group B). This result might highlight the difficulty to manage patients with both acute stroke and severe COVID-19 in terms of care pathway organization including prehospital management, emergency department regulation, interhospital transfers, and endovascular procedures as found in previous studies [8,9] from France [10], the stroke care network of Madrid [11], in Germany [4], in Lombardy and Italy [12]. These difficulties led to the publication of a guidance statement based on shared best practices in May 2020 [13].…”

Recent Advances in the Impact of Infection and Inflammation on Stroke Risk and Outcomes

“…The median duration from COVID-19 symptom onset to stroke diagnosis across several studies was approximately 12–16 days (with a range of 5–28 days) [ 21 •, 40 , 41 ]. Several studies have shown that COVID-19 infection is associated with higher stroke severity, worse functional outcomes, and greater mortality [ 40 , 42 ].…”

“…The median duration from COVID-19 symptom onset to stroke diagnosis across several studies was approximately 12–16 days (with a range of 5–28 days) [ 21 •, 40 , 41 ]. Several studies have shown that COVID-19 infection is associated with higher stroke severity, worse functional outcomes, and greater mortality [ 40 , 42 ]. The clear temporal relationship between COVID-19 symptom onset and acute stroke symptom onset supports the notion that pre-stroke infection does indeed detrimentally impact outcomes after stroke.…”

Severe Acute Respiratory Syndrome Coronavirus 2 Infection is Associated with Homocysteine Level and Clinical Outcomes in Ischemic Stroke Patients

“…However, more data is required to provide more robust evidence. Studies have shown that COVID-19 patients with acute ischemic stroke had a higher mortality rate [18], [19], [20]. Those who had ischemic stroke and COVID-19 had a higher rate of thrombotic events and a higher mortality rate (15% vs. 2.8%) [18].…”

“…Studies have shown that COVID-19 patients with acute ischemic stroke had a higher mortality rate [18], [19], [20]. Those who had ischemic stroke and COVID-19 had a higher rate of thrombotic events and a higher mortality rate (15% vs. 2.8%) [18]. A multicenter study in Spain found that ischemic stroke patients with COVID-19 had a mortality rate up to 39.3% compared to 16.1% only among those without COVID-19 [19].…”