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Coronavirus Disease 2019 Infection in Cervical Artery Dissections
Waseem Wahood1, Kelly D Flemming2, Giuseppe Lanzino3
1Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL.
Insights
The prevalence of coronavirus disease 2019 (COVID-19) in cervical artery dissection (CeAD) patients is low at 2.32%. While COVID-19 did not increase stroke risk or mortality, it was associated with poorer functional outcomes in CeAD patients.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Cervical artery dissection (CeAD) is often spontaneous or linked to minor trauma.
- Viral infections are suspected triggers for some CeAD cases.
- The impact of coronavirus disease 2019 (COVID-19) on CeAD is not well understood.
Purpose of the Study:
- To determine the prevalence of COVID-19 among hospitalized CeAD patients.
- To analyze the association between COVID-19 and stroke risk, mortality, and functional outcomes in CeAD patients.
Main Methods:
- Utilized the National Inpatient Sample database (April-December 2020).
- Identified patients with CeAD and COVID-19 using ICD-10-CM codes.
- Performed multivariable logistic regression to assess outcomes.
Main Results:
- 2.32% (360/15,500) of CeAD hospitalizations involved COVID-19.
- COVID-19 did not significantly increase the risk of acute ischemic stroke (43.06% vs. 43.73%).
- Fewer home discharges were observed in CeAD patients with COVID-19 (34.85% vs. 48.63%), but this was not statistically significant after regression analysis. In-patient mortality odds were similar.
Conclusions:
- The prevalence of concurrent COVID-19 infection in hospitalized CeAD patients is low.
- COVID-19 infection does not appear to elevate the risk of stroke in CeAD patients.
- Patients with CeAD and COVID-19 may experience worse functional outcomes, indicated by fewer home discharges, without a significant increase in mortality.
Objective:
Most cervical artery dissection (CeAD) cases are spontaneous or due to minor traumas, and preceding viral infections have been suggested to be a triggering event for CeAD in some. Herein, we analyze the prevalence of coronavirus disease 2019 (COVID-19) in hospitalized patients with CeAD using a national database.
Methods:
The National Inpatient Sample was queried from April 2020 to December 2020 for patients with a diagnosis of CeAD using International Classification of Diseases, 10th edition-Clinical Modification codes. Among these, patients with COVID-19 were identified. Multivariable logistic regression was conducted to assess the patient profile of those with COVID-19, in-patient mortality, and home discharge among patients with CeAD.
Results:
There were 360 (2.32%) hospitalizations involving COVID-19 among 15,500 with CeAD. Concomitant acute ischemic stroke constituted 43.06% of those with a COVID-19 diagnosis, whereas it was 43.73% among those without a COVID-19 diagnosis ( P = 0.902). Home discharges were less common in patients with COVID-19 and CeAD compared to CeAD alone (34.85% vs. 48.63%; P = 0.03), but this was likely due to other factors as multivariate regression analysis did not show an association between COVID-19 and home discharges (odds ratio: 0.69; 95% CI: 0.39 to 1.25; P = 0.22). COVID-19 diagnosis had similar odds of inpatient mortality (odds ratio: 1.11; 95% CI: 0.43 to 2.84; P = 0.84).
Conclusion:
The prevalence of COVID-19 among hospitalized patients with CeAD is low with 2.32% of all CeAD cases. Concomitant COVID infection did not lead to an increased risk of stroke in CeAD. However, potentially worse functional outcomes (fewer home discharges) without an increase in mortality were seen in patients with COVID and CeAD.
