4C Mortality Score correlates with in-hospital functional outcome after COVID-19-associated ischaemic stroke

Abstract

Aim of the study. The 4C Mortality Score was created to predict mortality in hospitalised patients with COVID-19 and has to date been evaluated only in respiratory system disorders. The aim of this study was to investigate its application in patients with COVID-19-associated acute ischaemic stroke (AIS).Clinical rationale for study. COVID-19 is a risk factor for AIS. COVID-19-associated AIS results in higher mortality and worse functional outcome. Predictors of functional outcome in COVID-19-associated AIS are required. Materials and methods.This was a retrospective observational study of patients with AIS hospitalised in seven neurological wards in Małopolska Voivodship (Poland) between August and December 2020. We gathered data concerning the patients' age, sex, presence of cardiovascular risk factors, type of treatment received, and the presence of stroke-associated infections (including pneumonia, urinary tract infection and infection of unknown source). We calculated 4C Mortality Score at stroke onset, and investigated whether there was a correlation with neurological deficit measured using the National Health Institute Stroke Scale (NIHSS) and functional outcome assessed using the modified Rankin Scale (mRS) at discharge. Results.The study included 52 patients with COVID-19-associated AIS. The 4C Mortality Score at stroke onset correlated with mRS (r s = 0.565, p < 0.01) at discharge. There was also a statistically significant difference in the mean 4C Mortality Score between patients who died and patients who survived the stroke (13.08 ± 2.71 vs. 9.85 ± 3.47, p = 0.04).Conclusions and clinical implications. 4C Mortality Score predicts functional outcome at discharge in COVID-19-associated AIS patients.

Course of fatigue among patients previously hospitalised due to COVID-19

“…Therefore, it seems that female sex is the only consistent risk factor for residual post-COVID fatigue, both in younger [40] and older populations [41]. Notably, our cohort consisted mainly of patients in a relatively good clinical condition prior to the SARS-CoV-2 infection, as the prevalence of diseases known to increase COVID-associated mortality, such as stroke, dementia and neoplasm, was below 10% [3,[42][43][44].…”

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

“…A high 4C score (≥15 out of 21) could identify patients at a high risk of mortality (positive predictive value 62%) [3]. This model has been further validated in several countries [1,[68][69][70][71][72][73]. Although some studies have shown a superior prognostic value of 4C over other risk scores such as CURB-65 [74][75][76], others did not show such a trend [77,78].…”

International study: Global impact of COVID-19 on stroke care — the Polish contribution

“…Although respiratory infection is the main clinical feature of COVID-19, the consequences of a SARS-Cov2 infection can also include coagulation disorders, cardiomyopathy and endotheliopathy, which are associated with stroke in up to 1.5% of patients. The sudden outbreak of the pandemic immediately favoured collaboration between Polish clinicians who have published several articles in this matter [1][2][3][4][5][6][7]. The transfer of knowledge between medical centres across the world was also important.…”