COVID-19 Infection is Associated with Stroke Subtype, Severity, and Outcomes in Patients with Acute Ischemic Stroke
Ian Rankine1, Kristin Salottolo1, Katie Higgins1, Anna Belits1, Frank Wang1, DaYoung Kim1, Yasaman Pirahanchi1, David Bar-Or1, Christian Burrell2
1Swedish Medical Center, 2Blue Sky Neurology
Objective:
To determine differences in patient demographics and stroke sub-type by COVID status at a US comprehensive stroke center.
Background:
In patients with severe COVID-19 infection there is an increased risk of cerebrovascular events, including acute ischemic stroke (AIS). In patients who present with COVID-19 infection and AIS, certain stroke subtypes have been reported with greater frequency.
Design/Methods:
We retrospectively evaluated adults (≥18) with AIS admitted during the first year of the COVID pandemic (3/1/2020 – 3/1/2021). Pearson chi-square tests were used to compared COVID+ vs COVID– patients for demographics (age, sex, race, comorbidities), stroke subtype (TOAST classification), severe stroke (NIHSS≥21), management (intravenous and intraarterial therapy [IVT and IAT]), and outcomes (in-hospital mortality and independent at discharge [mRS 0-2]).
Results:
Forty-four percent (475 of 1,086 AIS patients) were evaluated for COVID-19; most patients (94%) had PCR testing. Thirty-five (7%) patients were COVID+ and 441 (93%) were COVID–. Patients who were COVID+ were more likely to have cryptogenic stroke (62% vs. 32%, p<0.001), were more likely to report previous COVID infection (19% vs. 2%, p<0.001), were more likely to receive IVT (41% vs. 24%, p=0.03), and were less likely to be non-Hispanic white (53% vs. 71%, p=0.02) compared to COVID– patients. In-hospital mortality was significantly greater in COVID+ versus COVID– patients (12% vs. 4%, p=0.03); however, mRS 0-2 was similar: 29% vs. 27%. When comparing symptomatic (n=10) and asymptomatic (n=24) COVID+ patients, symptomatic patients were more likely to present with severe stroke (41% vs. 0%, p=0.03) and less likely to have mRS 0-2 (17% vs. 60%, p=0.04); there were no other demographic or clinical differences by symptomatology.
Conclusions:
Stroke etiology, stroke severity, and clinical outcomes can differ significantly based on COVID status. Patients with AIS and symptomatic COVID also have worse stroke severity and neurologic disability at discharge.
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