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Published on: January 18, 2018
Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort
Wouter M Sluis1, Marijke Linschoten2, Julie E Buijs3
1Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands.
Insights
The incidence of ischemic stroke in hospitalized coronavirus disease 2019 (COVID-19) patients was approximately 2%, with higher rates in intensive care units. COVID-19 stroke patients faced poor outcomes and increased mortality risk.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- The frequency of ischemic stroke in COVID-19 patients is variable, with unknown risk factors.
- Assessing stroke incidence, risk factors, and outcomes in hospitalized COVID-19 patients is crucial.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized COVID-19 patients.
- To compare risk factors, cardiovascular complications, and mortality between COVID-19 patients with and without ischemic stroke.
Main Methods:
- A multicenter cohort study included 2147 hospitalized patients with laboratory-confirmed SARS-CoV-2 infection.
- Patients were screened for acute ischemic stroke; cumulative incidence was calculated.
- Risk factors, cardiovascular complications, and in-hospital mortality were compared between patients with and without stroke.
Main Results:
- 1.8% (38/2147) of COVID-19 patients experienced ischemic stroke, with higher incidence in intensive care units (2.7% vs. 1.4%).
- Stroke patients were older but lacked differing cardiovascular risk factors; pulmonary embolism was more common (21.1% vs. 7.6%).
- 71.1% of stroke patients had poor outcomes (death or functional dependence), and stroke increased in-hospital mortality risk (aRR, 1.56).
Conclusions:
- The cumulative incidence of ischemic stroke in hospitalized COVID-19 patients was approximately 2%, higher in ICU patients.
- Most COVID-19 stroke patients experienced poor outcomes, highlighting the severity of this complication.
- The association between ischemic stroke and pulmonary embolism requires further investigation.
Background And Purpose:
The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19.
Methods:
We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke.
Results:
We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke.
Conclusions:
In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.
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