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Observational Study
. 2021;50(4):412-419.
doi: 10.1159/000514562. Epub 2021 Mar 30.

Clinical Outcome of Acute Ischemic Strokes in Patients with COVID-19

Julie Calmettes  1 , Roxane Peres  2 , Bruno Goncalves  3   4 , David Varlan  1 , Guillaume Turc  3 , Michael Obadia  2 , Clotilde Nardin  1 , Elodie Meppiel  1 , Thomas De Broucker  1 , Mikael Mazighi  5 , Aicha Lyoubi  1
Affiliations
Observational Study

Clinical Outcome of Acute Ischemic Strokes in Patients with COVID-19

Julie Calmettes et al. Cerebrovasc Dis. 2021.

Abstract

Introduction: Acute ischemic stroke (AIS) and thrombotic events (TEs) were reported in patients with COVID-19. Clinical outcome of AIS in the course of COVID-19 remains unknown. We compared early clinical outcome and mortality of COVID-positive (+) patients admitted for AIS with COVID-negative (-) ones. We hypothesized that COVID+ patients would have poorer clinical outcomes and present a higher rate of TEs and mortality compared with COVID- ones.

Methods: In this multicentric observational retrospective study, we enrolled patients over 18 years old admitted for AIS in 3 stroke units of the Parisian region during lockdown from March 17, 2020, to May 2, 2020. COVID-19 status as well as demographic, clinical, biological, and imaging data was collected retrospectively from medical records. Poor outcome was defined as modified Rankin score (mRS) 3-6 (3-6) at discharge. We also compared TE frequency and mortality rate through a composite criterion in both groups.

Results: Two hundred and sixteen patients were enrolled; mean age was 68 years old, and 63% were male. Forty patients were CO-VID+ (18.5%) and 176 were COVID-. Obesity was statistically more frequent in the COVID+ group (36 vs. 13% p < 0.01). The percentage of patients with mRS (3-6) at discharge was higher in the COVID+ group compared with the COVID- group (60 vs. 41%, p = 0.034). The main predictor of presenting a mRS (3-6) at discharge was high NIHSS score at admission (OR, CI 95%: 1.325, 1.22-1.43). Mortality rate was higher in the COVID+ group (12 vs. 3.4%, p = 0.033) as well as TE frequency (15 vs. 2.8%, p < 0.01).

Conclusion: In this study, patients with AIS infected by SARS-CoV-2 showed a poorer early outcome than COVID- ones. However, when compared to other factors, COVID-19 was not a significant predictor of poor outcome. Vascular morbidity and mortality rates were significantly higher in the COVID+ group compared with the COVID- group.

Keywords: Acute ischemic stroke; COVID-19; Outcome.

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Conflict of interest statement

No conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Distribution of mRS at discharge in both groups. mRS, modified Rankin Score; COVID−, COVID-negative; COVID+, COVID-positive.
Fig. 2
Fig. 2
Multiple ischemic lesions pattern in 3 COVID+ patients. Diffusion-weighted 1.5 T MRI. See arrows: hyperintensities in different arterial territories in 3 patients with COVID-19.
See this image and copyright information in PMC

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