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Acute Cerebrovascular Events With COVID-19 Infection
Mandip S Dhamoon1, Alison Thaler1, Kapil Gururangan1
1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York.
Insights
COVID-19 patients experiencing stroke had worse outcomes, including higher rates of neurological worsening and in-hospital death. These patients were more likely to have cryptogenic strokes in specific brain regions.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiovascular Medicine
Background:
- Coronavirus disease 2019 (COVID-19) is linked to increased thrombotic events, notably stroke.
- Limited data exists on the specific characteristics and outcomes of COVID-19 patients who suffer a stroke.
Purpose of the Study:
- To investigate the risk factors, stroke characteristics, and short-term outcomes in COVID-19 patients with stroke.
- To compare these factors between COVID-19-positive and COVID-19-negative stroke patients.
Main Methods:
- A retrospective observational study was conducted in a New York City health system.
- Data from consecutively admitted patients with acute cerebrovascular events between March 1, 2020, and April 30, 2020, were analyzed.
- Patients were stratified by COVID-19 status, examining demographics, comorbidities, stroke details, imaging, and in-hospital outcomes.
Main Results:
- Of 277 stroke patients, 38% were COVID-19-positive.
- COVID-19-positive patients more frequently had cryptogenic strokes and ischemic strokes in lobar regions.
- Worse outcomes were observed in COVID-19-positive patients, including longer hospital stays, increased ICU admissions, neurological worsening, and higher in-hospital mortality (33% vs. 12.9%).
Conclusions:
- While baseline characteristics were similar, COVID-19-positive stroke patients exhibited a higher likelihood of lobar strokes and cryptogenic causes.
- COVID-19 infection was associated with significantly poorer clinical outcomes in stroke patients.
Background And Purpose:
Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known.
Methods:
We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results.
Results:
Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P<0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal (P=0.02), parietal (P=0.002), occipital (P=0.002), and cerebellar (P=0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay (P<0.0001), greater percentage requiring intensive care unit care (P=0.017), and greater rate of neurological worsening during admission (P<0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P<0.0001).
Conclusions:
Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.
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