Acute ischemic strokes tend to be more severe, and are associated with a higher risk of mortality, if the patient has COVID-19, according to new data published in Stroke.
Researchers analyzed 701 patients, including 91 with COVID-19, who were treated at one of 19 hospitals in Spain from March to May 2020. Sixty-percent of the study’s patients were men, and the mean patient age was 72 years old.
All patients had an acute ischemic stroke within 48 hours of inclusion and presented with a previous modified Rankin Scale score of 0 to 3.
Overall, the median baseline National Institutes of Health Stroke Scale (NIHSS) score was higher in patients with COVID-19 compared than patients who did not have COVID-19 at the time of their stroke.
"We hypothesized that patients with ischemic stroke and COVID-19 infection would have worse prognosis," wrote lead author Joan Martí-Fàbregas, MD, PhD, with the department of neurology at Hospital de la Santa Creu i Sant Pau in Spain, and colleagues. "Despite presenting similar demographic, risk factor profile and time from the onset of symptoms, stroke severity measured by the NIHSS score was higher in the patients with COVID-19. Moreover, NIHSS score remained higher at 72 hours, thus reflecting the persistence of a worse neurological deficit."
Also, 33.7% of patients in the COVID-19 group and 47% of patients without COVID-19 had a favorable functional outcome. After a multivariable logistic regression analysis, COVID-19 did not appear to increase the probability of an unfavorable functional outcome.
COVID-19 patients also had a higher 90-day mortality rate (39.3% vs. 16.1%). In the group's multivariable logistic regression analysis, COVID-19 infection was independently associated with 90-day stroke mortality.
"It is important to emphasize that, despite a higher mortality, it seems that in patients with ischemic stroke there are no persistent effects of the viral infection that prevent a favorable recovery, or at least this probability is the same as that of patients who have suffered the stroke but without the COVID-19 infection," the authors wrote.
Martí-Fàbregas et al. wrote that that their study had multiple strengths, including its prospective design, the high number of patients with stroke and COVID-19, and the use of a control group treated at the same time.
The analysis had certain limitations as well. For instance, patients were recruited within 48 hours of the onset of their stroke.
"This prevented the inclusion of patients whose stroke was discovered after days or weeks in the ICU, and who often were intubated or under the effect of sedative medication," the authors wrote. "The stroke of these patients could be more severe and have different pathogenesis."
Future studies, the team added, should help clinicians learn more about the relationship between COVID-19 and acute ischemic strokes.
Click here to read the full study.