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Published on: August 18, 2015
COVID-19 and Stroke Recurrence by Subtypes: A Propensity-Score Matched Analyses of Stroke Subtypes in 44,994 Patients
Anna M Nia1, Visish M Srinivasan2, Rishi R Lall1
1Department of Neurosurgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA.
Insights
COVID-19 increases stroke risk in patients with prior cerebrovascular disease (CVD). Ischemic stroke history raises hemorrhagic stroke risk, while hemorrhagic stroke history elevates risk for recurrent hemorrhagic events.
Area of Science:
- Neurology
- Infectious Diseases
- Epidemiology
Background:
- Cerebrovascular diseases (CVDs) and stroke recurrence are concerns post-COVID-19 diagnosis.
- Risk factor stratification for stroke subtypes in COVID-19 patients needs further study.
- Large-scale propensity-score matched studies are crucial for understanding CVD recurrence post-COVID-19.
Purpose of the Study:
- To identify risk factors for stroke recurrence in patients with prior CVD and COVID-19.
- To stratify stroke recurrence risk based on stroke subtypes in COVID-19 patients.
- To compare outcomes in COVID-19 patients with prior CVD versus matched controls.
Main Methods:
- Analysis of data from 45 healthcare organizations using the TriNetX Analytics Network.
- Cohort creation based on ICD codes for various stroke subtypes.
- Propensity-score matching to compare COVID-19 patients with prior CVD to controls within 90 days.
Main Results:
- 22,497 patients with prior CVD and COVID-19 identified.
- COVID-19 patients with prior CVD showed increased hospitalization, ICU admission, and mortality.
- Ischemic stroke history increased hemorrhagic stroke/TIA risk (OR:1.59, 1.75); hemorrhagic stroke history increased hemorrhagic stroke risk (ORs 3.2, 1.7, 1.7).
Conclusions:
- COVID-19 is linked to higher hemorrhagic stroke and TIA risk in ischemic stroke patients.
- COVID-19 increases hemorrhagic stroke risk in patients with prior hemorrhagic stroke.
- No increased stroke risk was observed in TIA patients following COVID-19.
Background:
Cerebrovascular diseases (CVDs), including varying strokes, can recur in patients upon coronavirus disease 2019 (COVID-19) diagnosis, but risk factor stratification based on stroke subtypes and outcomes is not well studied in large studies using propensity-score matching. We identified risk factors and stroke recurrence based on varying subtypes in patients with a prior CVD and COVID-19.
Methods:
We analyzed data from 45 health care organizations and created cohorts based on ICDs for varying stroke subtypes utilizing the TriNetX Analytics Network. We measured the odds ratios and risk differences of hospitalization, ICU/critical care services, intubation, mortality, and stroke recurrence in patients with COVID-19 compared to propensity-score matched cohorts without COVID-19 within 90-days.
Results:
22,497 patients with a prior history of CVD within 10 years and COVID-19 diagnosis were identified. All cohorts with a previous CVD diagnosis had an increased risk of hospitalization, ICU, and mortality. Additionally, the data demonstrated that a history of ischemic stroke increased the risk for hemorrhagic stroke and transient ischemic attack (TIA) (OR:1.59, 1.75, p-value: 0.044*, 0.043*), but a history of hemorrhagic stroke was associated with a higher risk for hemorrhagic strokes only (ORs 3.2, 1.7, 1.7 and p-value: 0.001*, 0.028*, 0.001*). History of TIA was not associated with increased risk for subsequent strokes upon COVID-19 infection (all p-values: ≥ 0.05).
Conclusions:
COVID-19 was associated with an increased risk for hemorrhagic strokes and TIA among all ischemic stroke patients, an increased risk for hemorrhagic stroke in hemorrhagic stroke patients, and no associated increased risk for any subsequent strokes in TIA patients.
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