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Published on: September 17, 2014
Mortality following mechanical thrombectomy for ischemic stroke in patients with COVID-19
Jonathan Dallas1, Talia A Wenger2, Kristie Q Liu2
1Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Insights
COVID-19 diagnosis independently predicts increased mortality in patients undergoing mechanical thrombectomy for stroke. While not affecting discharge disposition, the virus poses a significant risk, likely due to inflammation and hypercoagulability.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Previous studies suggest a link between COVID-19 and stroke, impacting thrombectomy rates and outcomes.
- The specific association between COVID-19 and patient outcomes after mechanical thrombectomy requires further investigation using recent data.
Purpose of the Study:
- To assess the independent effect of COVID-19 diagnosis on in-hospital mortality and discharge disposition in patients undergoing mechanical thrombectomy for arterial stroke.
Main Methods:
- A large-scale analysis of the 2020 National Inpatient Sample.
- Identification of patients with arterial stroke undergoing mechanical thrombectomy using ICD-10 codes.
- Stratification of patients based on COVID-19 diagnosis (positive vs. negative) and multivariable analysis controlling for covariates.
Main Results:
- Out of 5078 patients, 166 (3.3%) had COVID-19.
- COVID-19 positive patients exhibited significantly higher in-hospital mortality (30.1% vs. 12.4%, p < 0.001).
- COVID-19 was an independent predictor of increased mortality (OR 1.13, p=0.002) after controlling for confounders. No significant association with discharge disposition was found.
Conclusions:
- COVID-19 is an independent predictor of mortality in patients undergoing mechanical thrombectomy.
- Potential contributing factors include multisystem inflammation, hypercoagulability, and re-occlusion associated with COVID-19.
- Further research is warranted to elucidate the mechanisms underlying this association.
Objectives:
Multiple prior studies have shown a relationship between COVID-19 and strokes; further, COVID-19 has been shown to influence both time-to-thrombectomy and overall thrombectomy rates. Using large-scale, recently released national data, we assessed the association between COVID-19 diagnosis and patient outcomes following mechanical thrombectomy.
Materials And Methods:
Patients in this study were identified from the 2020 National Inpatient Sample. All patients with arterial strokes undergoing mechanical thrombectomy were identified using ICD-10 coding criteria. Patients were further stratified by COVID diagnosis (positive vs. negative). Other covariates, including patient/hospital demographics, disease severity, and comorbidities were collected. Multivariable analysis was used to determine the independent effect of COVID-19 on in-hospital mortality and unfavorable discharge.
Results:
5078 patients were identified in this study; 166 (3.3%) were COVID-19 positive. COVID-19 patients had a significantly higher mortality rate (30.1% vs. 12.4%, p < 0.001). When controlling for patient/hospital characteristics, APR-DRG disease severity, and Elixhauser Comorbidity Index, COVID-19 was an independent predictor of increased mortality (OR 1.13, p = 0.002). COVID-19 was not significantly related to discharge disposition (p = 0.480). Older age and increased APR-DRG disease severity were also correlated with increase morality.
Conclusions:
Overall, this study indicates that COVID-19 is a predictor of mortality among mechanical thrombectomy. This finding is likely multifactorial but may be related to multisystem inflammation, hypercoagulability, and re-occlusion seen in COVID-19 patients. Further research would be needed to clarify these relationships.
