COVID-19 Linked with Worse Stroke Outcomes, Increased Mortality Risk

A new analysis of The Global COVID-19 Stroke Registry suggests that acute ischemic strokes associated with the coronavirus tended to have worse outcomes and higher rates of mortality than typical ischemic strokes.

“Recent case-series of small size implied a pathophysiological association between COVID-19 and severe large-vessel acute ischemic stroke,” the authors wrote in their abstract in Stroke. “Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways.”

The analysis looked at patients from 28 different centers in 16 countries hospitalized with COVID-19 and acute ischemic stroke between late January and May 2020. The study population included 174 patients matched with non-COVID acute stroke patients. Those included in the study were matched based on prespecified factors such as age, gender, and stroke risk factors (hypertension, diabetes, atrial fibrillation, etc.). The final study cohort with the matched patients (1:1) was comprised of 330 patients. The researchers evaluated stroke severity using the National Institute of Health Stroke Scale (NIHSS), with outcomes assessed using the modified Rankin score (mRS).

According to the results, the median NIHSS score was 10. Patients with COVID-19 had higher NIHSS scores compared to those without (10 vs. 6, P=0.03). There were 48 deaths in the study population (22 attributed to COVID-19 and 26 to stroke). Among the survivors, 49 (51%) of them had severe disability at discharge. Patients with COVID-19 had a higher risk for severe disability than those without (media mRS 4 vs. 2, P<0.001), and a higher mortality risk as well (OR=4.3; 95% CI, 2.22 to 8.20) compared to those without COVID-19.

“The increased stroke severity at admission in COVID-19-associated stroke patients compared to the non-COVID-19 cohort may explain the worse outcomes,” the authors said in a press release. “The broad, multi-system complications of COVID-19, including acute respiratory distress syndrome, cardiac arrhythmias, acute cardiac injury, shock, pulmonary embolism, cytokine release syndrome and secondary infection, probably contribute further to the worse outcomes including higher mortality in these patients.”