Stroke in Patients with COVID-19 Infection in a Tertiary Hospital: A Retrospective Study

Abstract

Introduction. Stroke can be a complication and/or a presenting sign of COVID-19 infection. Although there is growing evidence on stroke in COVID-19 infection, only a few of these studies were done in Asia and there is very scarce evidence in the local setting.Objective. This study aimed to characterize the clinical profile, management, and functional outcome of patients with acute stroke and COVID-19 infection.Methods. This was a single-center retrospective study from March 30 to October 20, 2020. The demographic characteristics, respiratory symptoms, risk factors, neuroimaging, stroke characteristics, ancillary test results, treatment given, and functional outcome were obtained through a review of medical records. Computation of the mean, standard deviation, median, interquartile range, total count, and percentage was done for data analysis.Results. Out of 2,018 patients with COVID-19 infection, 41 (2%) developed an acute stroke. The mean age of patients was 59.05 ± 14.04 years. Majority were men (n=24, 59%). Ischemic stroke (n=28, 68%) was the most common stroke with the anterior circulation commonly involved (n=21, 72%). The most common risk factors were hypertension (n=31, n=76%), cigarette smoking (n=18, 44%), dyslipidemia (n=16, 39%), and ethanol use (n=16, 39%). Among those with stroke and COVID-19 infection, 42% had mild infection and 29% had critical disease. The inflammatory markers were elevated in these patients. Upon discharge, 83% had a poor functional outcome (mRS 3-6). The overall mortality rate was high (n=24, 59%) with pulmonary cause as the most common cause of death. Conclusion.Ischemic stroke was the most common stroke type in patients infected with COVID-19. The common risk factors were hypertension, dyslipidemia, smoking, ethanol use, and diabetes mellitus. The functional outcome was generally poor and the mortality rate was high. More studies are needed that compare these subsets of patients with a control group, including a longer follow up.

Incidence and risk factors for stroke in patients with COVID-19 in the Philippines: An analysis of 10,881 cases

“…9 Moreover, compared to global (3.4% vs. 1.5%) or smaller cross-sectional local data (3.4% vs. 2.0%), the incidence was still higher in our study. 1,13 This was despite the decline of stroke admissions in Asia was considerably higher compared to the global average (20.5% vs. 19.2%). 1 Although it can be argued that the difference may be explained by the higher incidence of COVID-19 infections across Europe and North America and higher baseline stroke admissions in Asia; our study had a larger 881) than that of another study (n = 8163).…”

“…9 , 15 However, when we did a regression analysis to control for predictors, smoking, hypertension, presence of heart failure, presence of past neurologic co-morbidities, and past history of stroke still yielded a significant association with the occurrence of stroke among COVID-19 patients, similar to other studies. 9 , 10 , 13 …”

“…9,15 However, when we did a regression analysis to control for predictors, smoking, hypertension, presence of heart failure, presence of past neurologic co-morbidities, and past history of stroke still yielded a significant association with the occurrence of stroke among COVID-19 patients, similar to other studies. 9,10,13 It was previously established that the prevalence of dyslipidemia, DM, central obesity, and others were higher among Asians than Europeans, thus explaining the risk of stroke. 14 However, compared to other studies with larger sample size, the proportions of hypertension (69.5% vs. 85%), DM (32.2% vs. 56%), and heart failure (4.4% vs. 33%) in ours were considerably lower.…”

“…[10][11][12] While most large studies about the possible association of COVID-19 and stroke were done in high-income countries, only one study with a small sample size have been done in low-to middle-income countries (LMIC) like the Philippines. 13 Developed countries have more organized and advanced health care systems and reliable national insurance services; hence, the incidence of stroke, its risk factors and mortality rate among COVID-19 patients may not be comparable to the true situation in LMIC. 6,8 A recently concluded nationwide multicenter, comparative, retrospective cohort study was conducted from February to December 2020 to identify the different neurologic manifestations of COVID-19 in the Philippines.…”