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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Functional outcomes of COVID-19 patients with acute ischemic stroke: A prospective, observational, single-center
Majdi Al Qawasmeh1, Yaman B Ahmed2, Omar A Nsour2
1Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Insights
Patients with ischemic stroke and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experienced increased stroke severity and mortality. However, SARS-CoV-2 infection did not significantly impact the likelihood of unfavorable outcomes at three months.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Ischemic stroke is a leading cause of disability and mortality worldwide.
- The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on stroke outcomes is not fully understood.
- Understanding these associations is crucial for managing patients with both conditions.
Purpose of the Study:
- To assess differences in stroke severity, functional outcome, and mortality in ischemic stroke patients with and without SARS-CoV-2 infection.
- To identify predictors of unfavorable outcomes in ischemic stroke patients.
- To evaluate the specific impact of SARS-CoV-2 on stroke patient prognosis.
Main Methods:
- Prospective, single-center cohort study of 178 ischemic stroke patients from October 2020 to October 2021.
- Data collection included demographics, risk factors, NIH Stroke Scale (NIHSS), stroke subtype (TOAST), treatments, and laboratory variables.
- Primary endpoint: modified Rankin Score at 3 months; secondary outcomes: in-hospital and 3-month mortality.
Main Results:
- COVID-19 positive patients had significantly higher NIHSS scores at baseline, 72 hours, and discharge compared to COVID-19 negative patients.
- COVID-19 positive patients showed a higher median modified Rankin Score at 3 months.
- Higher NIHSS score at admission predicted unfavorable outcomes, while SARS-CoV-2 infection did not significantly impact outcome likelihood.
Conclusions:
- SARS-CoV-2 infection is associated with increased stroke severity and in-hospital mortality in ischemic stroke patients.
- Despite increased severity, concomitant SARS-CoV-2 infection did not significantly alter the likelihood of unfavorable functional outcomes at 3 months.
- NIHSS score at admission remains a key predictor of long-term functional outcomes in ischemic stroke.
Abstract:
We assessed whether stroke severity, functional outcome, and mortality in patients with ischemic stroke differed between patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and those without. We conducted a prospective, single-center cohort study in Irbid, North Jordan. All patients diagnosed with ischemic stroke and SARS-CoV-2 infection were consecutively recruited from October 15, 2020, to October 16, 2021. We recorded demographic data, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, stroke subtype according to the Trial of ORG 10172 in Acute Stroke Treatment Criteria (TOAST), treatments at admission, and laboratory variables for all patients. The primary endpoint was the functional outcome at 3 months assessed using the modified Rankin Score. Secondary outcomes involved in-hospital mortality and mortality at 3 months. We included 178 patients with a mean (standard deviation) age of 67.3 (12), and more than half of the cases were males (96/178; 53.9%). Thirty-six cases were coronavirus disease 2019 (COVID-19) related and had a mean (standard deviation) age of 70 (11.5). When compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a higher median NIHSS score at baseline (6 vs 11; P = .043), after 72 hours (6 vs 12; P = .006), and at discharge (4 vs 16; P < .001). They were also more likely to have a higher median modified Rankin Score after 3 months of follow-up (P < .001). NIHSS score at admission (odds ratio = 1.387, 95% confidence interval = 1.238-1.553]; P < .001) predicted having an unfavorable outcome after 3 months. On the other hand, having a concomitant SARS-CoV-2 infection did not significantly impact the likelihood of unfavorable outcomes (odds ratio = 1.098, 95% confidence interval = 0.270-4.473; P = .896). The finding conclude that SARS-CoV-2 infection led to an increase in both stroke severity and in-hospital mortality but had no significant impact on the likelihood of developing unfavorable outcomes.
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