Patients with COVID-19 Infection and Stroke have Higher than Expected Mortality, Regardless of the Primary Presentation
Jintong Liu1, Riley Gillette1, Sharon Poisson2, Kerri Jeppson1, Brandy Ravare1, Max Wohlauer1
1University of Colorado School of Medicine, 2University of Colorado Denver
Objective:

We aimed to characterize patients with COVID-19 and stroke and compare outcomes with patients with stroke only in the hospital setting.

Background:

COVID-19 infection is associated with a hypercoagulable state which results in thrombotic events, such as ischemic stroke. However, few studies have reported patient outcomes based on the primary presentation (COVID-19 or stroke first), and the association between COVID-19 and hemorrhagic stroke in the hospital setting.

Design/Methods:

We retrospectively reviewed and characterized all patients (N=66) who were COVID-19 positive at the time of ischemic or hemorrhagic presentation to a tertiary medical center between March 2020 and December 2020. This cohort was compared with patients who were COVID-19 negative at the time of stroke presentation in the same period (N=537). Statistical significance was evaluated using Pearson’s Chi-squared test with Yates’ continuity correction.

Results:

The mean age of stroke patients with COVID-19 was 62.1 years old with 62.1% identified as male and 37.9% as female, which is similar to the cohort without COVID-19 (mean age=64.7). Of the COVID-19 positive patients, multiple comorbidities were identified including hypertension (68.2%), diabetes mellitus (56.1%), and hyperlipidemia (36.4%). 22 (33.4%) patients initially presented with stroke and 44 (66.7%) initially presented with COVID-19. Overall mortality was 37.9% with 36.4% in the stroke-first cohort and 38.6% in the COVID-first cohort. This is significantly higher than patients who had a stroke only (17.3%, p<0.001). In the stroke-first cohort, 22.7% patients presented with a hemorrhagic stroke and 77.2% with an ischemic stroke. In the COVID-first cohort, 38.6% experienced a hemorrhagic stroke while 61.4% had an ischemic stroke with similar mortality rates.

Conclusions:

In the early pandemic, we found that patients with COVID-19 infection and stroke, regardless of the primary presentation, had a higher mortality rate than patients with only stroke. Mortality rates were similar between patients with a hemorrhagic stroke and an ischemic stroke.

10.1212/WNL.0000000000202104