COVID-19-related strokes are associated with increased mortality and morbidity: A multicenter comparative study from Bengaluru, South India

Abstract

Background: COVID-19 related strokes (CORS) are increasingly being diagnosed across the world. The knowledge about the clinical profile, imaging findings and outcomes are still evolving. Here we describe the characteristics of a cohort of 62 CORS patients from 13 hospitals, from Bangalore city, south India. Objective: To describe the clinical profile, neuroimaging findings, interventions and outcomes in CORS patients Methods: Multicenter retrospective study of all CORS patients from 13 hospitals from south India from 1st June 2020 to 31st August 2020.Demographic, clinical, laboratory and neuroimaging data were collected along with treatment administered and outcomes. SARS-CoV-2 infection was confirmed in all cases by RT- PCR testing. The data obtained from the case records were entered in SPSS 25 for statistical analysis. Results: During the 3-month period we had 62 CORS patients, across 13 centers. 60 (97%) had ischemic strokes while 2 (3%) had hemorrhagic strokes. The mean age of patients was 55.66 ±13.20 years, with 34 (77.4%) males. 26 % (16/62) of patients did not have any conventional risk factors for stroke. Diabetes Mellitus was seen in 54.8%, hypertension was present in 61.3%, coronary artery disease in 8% and atrial fibrillation in 4.8%. Base line NIHSS score was 12.7 ±6.44. Stroke severity was moderate (NIHSS 5-15) in 27 (61.3%) patients, moderate to severe (NIHSS 16-20) in 13 (20.9%) patients and severe (NIHSS 21-42) in 11(17.7%) patients. According to TOAST classification for ischemic strokes, 48.3% was stroke of undetermined etiology, 36.6% had large artery atherosclerosis, 10% had small vessel occlusion and 5% had cardioembolic strokes. 3 (5%) received intravenous thrombolysis with tenecteplase 0.2 mg/Kg and 3 (5%) underwent mechanical thrombectomy two endovascular and one surgical. Duration of hospital stay was 16.16± 6.39 days. 16% (13/62) died in hospital, while 37 (59.7%) had a mRS of 3-5 at discharge. Hypertension, atrial fibrillation and higher baseline NIHSS scores were associated with increased mortality. A comparison to 111 historical controls during the non COVID period showed a higher proportion of strokes of undetermined etiology, higher mortality and higher morbidity in CORS patients. Conclusion:CORS are increasing being recognized in developing countries like India. Stroke of undetermined etiology appears to be the most common TOAST subtype of CORS. CORS were more severe in nature and resulted in higher mortality and morbidity. Hypertension, atrial fibrillation and higher baseline NIHSS scores were associated with increased mortality.

Do Elevated Levels of Inflammatory Biomarkers Predict the Risk of Occurrence of Ischemic Stroke in SARS-CoV2 ?: An Observational Study

“…We found multiple vascular territory infarcts, bilateral infarcts, and simultaneous anterior and posterior circulation infarcts in 55%, 41.66%, and 23.33% patients respectively. According to TOAST classification, the majority of the patients (55%, n=33) had a cryptogenic stroke, as reported previously, 2,5,29 and only 5% (n = 3) had a cardio-embolic stroke. However, on applying the MRI-based criterion 18 for identifying the pattern of stroke, brain imaging was suggestive of an embolic pattern of infarction in 50% of the patients.…”

Characteristics and outcomes of 100 consecutive patients with acute stroke and COVID-19

“…Ntaios et al [7] in the Global COVID-19 stroke registry study compared COVID-19 AIS with non-COVID-19 strokes and found the mortality to be significantly higher in those with COVID-19. Mathew et al [8] recently demonstrated similar findings of increased mortality and morbidity in those with COVID-19 as compared to the non-COVID-19 ischemic stroke controls. However, their control group had 54% patients with mild stroke and zero in hospital mortality.…”

“…Stroke in COVID-19 though uncommon, results in significant morbidity and mortality [6,7]. As recent research indicates that stroke can be a presenting feature of COVID-19 [6] and there is limited data from the Indian subcontinent [8], we evaluated 100 consecutive acute stroke patients with COVID-19 from western India. We also included patients with cerebral venous thrombosis and intracerebral haemorrhage associated with COVID-19 as the information on these stroke subtypes is scant [5,9,10,11,12].…”

Clinical and Demographic Predictors of Mortality due to COVID-19 Pandemic: A Retrospective Study

“…[2] With the rising prevalence of cardio metabolic disorders globally, individuals with Diabetes Mellitus, Hypertension and such conditions can highly influence their health status in a dreadful way. [3] In some cases like elderly, patients with co morbidities and immune suppression, it may progress to acute respiratory distress syndrome (ARDS). [4] The possible reason behind lower mortality figures in India when compared to other countries is unclear.…”