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Impact of COVID-19 on ischemic stroke patterns and outcomes: a multicenter retrospective study using propensity score
Daniyah A Almarghalani1,2, Khulood A Almehmadi3, Alaa M Hammad4
1Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, Taif, Saudi Arabia.
Insights
Coronavirus disease 2019 (COVID-19) significantly worsens ischemic stroke outcomes. COVID-19 patients experienced longer hospital stays, higher rates of pneumonia, cognitive impairment, and in-hospital mortality compared to non-COVID-19 patients.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- The impact of COVID-19 on ischemic stroke outcomes is not well-defined, especially in Middle Eastern populations.
- This study investigates stroke complications and in-hospital outcomes in COVID-19 positive versus negative patients.
Purpose of the Study:
- To evaluate the effect of COVID-19 on ischemic stroke complications.
- To compare in-hospital outcomes for ischemic stroke patients with and without COVID-19.
Main Methods:
- Retrospective analysis of 820 ischemic stroke patients from Saudi Arabia (March 2020-March 2021).
- Propensity score matching (2:1) created a cohort of 327 patients (109 COVID-19, 218 non-COVID-19).
- Conditional logistic regression compared clinical outcomes between groups.
Main Results:
- COVID-19 patients had longer hospital stays (5 vs. 3 days) and higher rates of pneumonia (54.1% vs. 10.6%).
- Cognitive impairment (11.9% vs. 2.8%) and in-hospital mortality (23.9% vs. 10.1%) were significantly higher in COVID-19 patients.
- COVID-19 was independently associated with increased risk of pneumonia, cognitive impairment, and death.
Conclusions:
- COVID-19 infection independently exacerbates ischemic stroke outcomes.
- Increased risks include pneumonia, cognitive impairment, and in-hospital mortality.
- Enhanced monitoring and prioritization of high-risk stroke patients during outbreaks are recommended.
Background:
The impact of coronavirus disease 2019 (COVID-19) on ischemic stroke outcomes remains uncertain, particularly in multicenter Middle Eastern cohorts. This study aimed to assess stroke-related complications and in-hospital outcomes in patients with and without COVID-19 using a propensity score-matched design.
Methods:
We retrospectively analyzed 820 ischemic stroke patients admitted to three tertiary hospitals in Saudi Arabia between March 2020 and March 2021. Among these patients, 711 had no COVID-19, and 109 had confirmed COVID-19. Propensity score matching (2:1) was performed on the basis of age, sex, smoking status, diabetes status, hypertension status, and ischemic heart disease, resulting in a matched cohort of 327 patients (218 non-COVID-19 patients and 109 COVID-19 patients). Clinical outcomes were compared via conditional logistic regression.
Results:
After matching, COVID-19 patients had significantly longer hospital stays (median 5 vs. 3 days, p = 0.044) and higher rates of pneumonia (54.1% vs. 10.6%, p < 0.001), cognitive impairment (11.9% vs. 2.8%, p = 0.001), and in-hospital mortality (23.9% vs. 10.1%, p = 0.001). COVID-19 infection was significantly associated with pneumonia (OR = 10.88; 95% CI: 5.36-22.08, p < 0.001), cognitive impairment (OR = 5.81; 95% CI: 1.87-18.00, p = 0.002), and in-hospital death (OR = 2.98; 95% CI: 1.53-5.79, p = 0.001).
Conclusion:
COVID-19 infection independently worsens ischemic stroke outcomes, increasing the risk of pneumonia, cognitive impairment, and in-hospital mortality even after adjustment for baseline factors. These findings highlight the need for intensified respiratory and neurological monitoring and may guide the clinical prioritization of high-risk stroke patients during infectious disease outbreaks.
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