Impact of COVID-19 infection on the outcome of patients with ischemic stroke

Martí-Fàbregas, J, Guisado-Alonso, D, Delgado-Mederos, R, Martínez-Domeño, A, Prats-Sánchez, L, Guasch-Jiménez, M, Cardona, P, Núñez-Guillén, A, Requena, M, Rubiera, M, Olivé, M, Bustamante, A, Gomis, M, Amaro, S, Llull, L, Ustrell, X, de Oliveira, GC, Seró, L, Gomez-Choco, M, Mena, L, Serena, J, Viturro, SB, Purroy, F, Vicente, M, Rodríguez-Campello, A, Ois, A, Catena, E, Garcia-Carreira, MC, Barrachina, O, Palomeras, E, Krupinski, J ORCID: https://orcid.org/0000-0002-5136-8898, Almeria, M, Zaragoza, J, Esteve, P, Cocho, D, Moreira, A, van Eendenburg, C, Codas, JE, de la Ossa, NP, Salvat, M and Camps-Renom, P (2021) Impact of COVID-19 infection on the outcome of patients with ischemic stroke. Stroke, 52 (12). pp. 3908-3917. ISSN 0039-2499

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Abstract

BACKGROUND AND PURPOSE: We evaluated whether stroke severity, functional outcome, and mortality are different in patients with ischemic stroke with or without coronavirus disease 2019 (COVID-19) infection. METHODS: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had an acute ischemic stroke within 48 hours and a previous modified Rankin Scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, National Institutes of Health Stroke Scale score, rate of reperfusion therapies, logistics, and metrics. Primary end point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariable analyses. RESULTS: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men) and 91 (13%) had COVID-19 infection. Median baseline National Institutes of Health Stroke Scale score was higher in patients with COVID-19 compared with patients without COVID-19 (8 [3–18] versus 6 [2–14], P=0.049). Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariable logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among patients with COVID-19 and 16.1% in the non-COVID-19 group. In the multivariable logistic regression analysis, COVID-19 infection was a risk factor for mortality (hazard ratio, 3.14 [95% CI, 2.10–4.71]; P<0.001). CONCLUSIONS: Patients with ischemic stroke and COVID-19 infection have more severe strokes and a higher mortality than patients with stroke without COVID-19 infection. However, functional outcome is comparable in both groups.