Incidence, characteristics and clinical relevance of acute stroke in old patients hospitalized with COVID-19

Abstract

Background Stroke in the course of coronavirus disease (COVID-19) has been shown to be associated with more severe respiratory symptoms and higher mortality, but little knowledge in this regard exists on older populations. We aimed to investigate the incidence, characteristics, and prognosis of acute stroke in geriatric patients hospitalized with COVID-19. Methods A monocentric cross-sectional retrospective study of 265 older patients hospitalized with COVID-19 on acute geriatric wards. 11/265 presented a stroke episode during hospitalization. Mortality rates and two-group comparisons (stroke vs non-stroke patients) were calculated and significant variables added in logistic regression models to investigate stroke risk factors. Results Combined ischemic and hemorrhagic stroke incidence was 4.15%. 72.7% of events occurred during acute care. Strokes presented with altered state of consciousness and/or delirium in 81.8%, followed by a focal neurological deficit in 45.5%. Ischemic stroke was more frequently unilateral (88.8%) and localized in the middle cerebral artery territory (55.5%). Smoking and a history of previous stroke increased by more than seven (OR 7.44; 95% CI 1.75–31.64; p = 0.007) and five times (OR 5.19; 95% CI 1.50–17.92; p = 0.009), respectively, the risk of stroke. Each additional point in body mass index (BMI) reduced the risk of stroke by 14% (OR 0.86; 95% CI 0.74–0.98; p = 0.03). In-hospital mortality (32.1% vs. 27.3%; p > 0.999) and institutionalization at discharge (36.4% vs. 21.1%; p = 0.258) were similar between patients with and without stroke. Conclusion Incident stroke complicating COVID-19 in old patients was associated with active smoking, previous history of stroke, and low BMI. Acute stroke did not influence early mortality or institutionalization rate at discharge.

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

“…Stroke risk ranged from 0.5% (33) to 1.6% [ 43 ]. The interval between onset of COVID-19 symptoms and stroke varied from 1 to 27 days (predominantly 6–10 days) [ 43 – 49 ]. Stroke occurred during a hospital stay in 56.2% (18 of 32) of cases in one study [ 44 ] and in 74.2% in another study (23/31 with acute ischemic stroke) [ 43 ].…”

“…Ischemic stroke predominated, followed by haemorrhagic stroke. Of ischemic stroke cases, those of undetermined etiology (cryptogenic stroke) or due to involvement of large vessels were commonly reported [ 43 – 45 , 47 – 49 ]. Patients with symptomatic COVID-19 + and stroke were compared with asymptomatic COVID-19 + patients with stroke or with contemporary or antecedent COVID-19 negative stroke patients.…”

“…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 ].…”

Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis

“…A total of 36 articles were included in the pooled analysis ( Table 1 ). 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 The majority (28; 78%) consisted of retrospective cohort studies whereas three (8%) were RCTs and five (14%) were prospective cohort studies ( Table 1 ).…”

Anticoagulated de novo atrial flutter complicated by transitory ischemic attack in fatal COVID‐19

“…1 One of the central nervous system (CNS) manifestations is ischemic stroke. 2 The cause of ischemic stroke in COVID-19 patients is multifactorial. One of these causes is cardiovascular disease, which can manifest as heart failure, arterial hypertension, or atrial fibrillation/flutter, and the other is hypercoagulability syndrome, increasingly recognized as a complication of COVID-19.…”