Impact of COVID-19 Infection on the Outcome of Patients With Ischemic Stroke

Joan Martí-Fàbregas¹, Daniel Guisado-Alonso¹, Raquel Delgado-Mederos¹, Alejandro Martínez-Domeño¹, Luis Prats-Sánchez¹, Marina Guasch-Jiménez¹, Pere Cardona², Ana Núñez-Guillén², Manuel Requena³, Marta Rubiera³, Marta Olivé³, Alejandro Bustamante⁴, Meritxell Gomis⁴, Sergio Amaro⁵, Laura Llull⁵, Xavier Ustrell⁶, Gislaine Castilho de Oliveira⁶, Laia Seró⁶, Manuel Gomez-Choco⁷, Luis Mena⁷, Joaquín Serena⁸, Saima Bashir Viturro⁸, Francisco Purroy⁹, Mikel Vicente⁹, Ana Rodríguez-Campello¹⁰, Angel Ois¹⁰, Esther Catena¹¹, Maria Carmen Garcia-Carreira¹², Oriol Barrachina¹², Ernest Palomeras¹³, Jerzky Krupinski¹⁴, Marta Almeria¹⁴, Josep Zaragoza¹⁵, Patricia Esteve¹⁵, Dolores Cocho¹⁶, Antia Moreira^{10

17}, Cecile van Eendenburg¹⁸, Javier Emilio Codas¹⁹, Natalia Pérez de la Ossa²⁰, Mercè Salvat²⁰, Pol Camps-Renom¹; COVICTUS Collaborators

Affiliations

¹ Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (J.M.-F., D.G.-A., R.D.-M., A.M.-D., L.P.-S., M.G.-J., P.C.-R.).
² Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Spain (P.C., A.N.-G.).
³ Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M. Requena, M. Rubiera, M.O.).
⁴ Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Spain (A.B., M.G.).
⁵ Department of Neurology, Hospital Universitari Clinic, Barcelona, Spain (S.A., L.L.).
⁶ Department of Neurology, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., G.C.d.O., L.S.).
⁷ Department of Neurology, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain (M.G.-C., L.M.).
⁸ Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain (J.S., S.B.V.).
⁹ Stroke Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P., M.V.).
¹⁰ Department of Neurology, Hospital del Mar, Barcelona, Spain (A.R.-C., A.O., A.M.).
¹¹ Department of Neurology, Hospital comarcal de l'Alt Penedès, Vilafranca del Penedès, Spain (E.C.).
¹² Department of Neurology, Hospital Universitari Parc Taulí, Sabadell, Spain (M.C.G.-C., O.B.).
¹³ Department of Neurology, Hospital de Mataró, Spain (E.P.).
¹⁴ Department of Neurology, Hospital Universitari Mútua de Terrassa, Spain (J.K., M.A.).
¹⁵ Department of Neurology, Hospital de Tortosa Verge de la Cinta, Spain (J.Z., P.E.).
¹⁶ Department of Neurology, Hospital General de Granollers, Spain (D.C.).
¹⁷ Department of Neurology, Hospital d'Igualada, Spain (A.M.).
¹⁸ Department of Neurology, Hospital de Figueres, Spain (C.v.E.).
¹⁹ Department of Neurology, Consorci Sanitari de Terrassa, Spain (J.E.C.).
²⁰ Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (N.P.d.l.O., M.S.).

PMID: 34455823
PMCID: PMC8607902
DOI: 10.1161/STROKEAHA.121.034883

Observational Study

Impact of COVID-19 Infection on the Outcome of Patients With Ischemic Stroke

Joan Martí-Fàbregas et al. Stroke. 2021 Dec.

. 2021 Dec;52(12):3908-3917.

doi: 10.1161/STROKEAHA.121.034883. Epub 2021 Aug 30.

Authors

Affiliations

¹ Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (J.M.-F., D.G.-A., R.D.-M., A.M.-D., L.P.-S., M.G.-J., P.C.-R.).
² Department of Neurology, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Spain (P.C., A.N.-G.).
³ Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain (M. Requena, M. Rubiera, M.O.).
⁴ Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Spain (A.B., M.G.).
⁵ Department of Neurology, Hospital Universitari Clinic, Barcelona, Spain (S.A., L.L.).
⁶ Department of Neurology, Hospital Universitari Joan XXIII, Tarragona, Spain (X.U., G.C.d.O., L.S.).
⁷ Department of Neurology, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain (M.G.-C., L.M.).
⁸ Department of Neurology, Hospital Universitari Dr. Josep Trueta, Girona, Spain (J.S., S.B.V.).
⁹ Stroke Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P., M.V.).
¹⁰ Department of Neurology, Hospital del Mar, Barcelona, Spain (A.R.-C., A.O., A.M.).
¹¹ Department of Neurology, Hospital comarcal de l'Alt Penedès, Vilafranca del Penedès, Spain (E.C.).
¹² Department of Neurology, Hospital Universitari Parc Taulí, Sabadell, Spain (M.C.G.-C., O.B.).
¹³ Department of Neurology, Hospital de Mataró, Spain (E.P.).
¹⁴ Department of Neurology, Hospital Universitari Mútua de Terrassa, Spain (J.K., M.A.).
¹⁵ Department of Neurology, Hospital de Tortosa Verge de la Cinta, Spain (J.Z., P.E.).
¹⁶ Department of Neurology, Hospital General de Granollers, Spain (D.C.).
¹⁷ Department of Neurology, Hospital d'Igualada, Spain (A.M.).
¹⁸ Department of Neurology, Hospital de Figueres, Spain (C.v.E.).
¹⁹ Department of Neurology, Consorci Sanitari de Terrassa, Spain (J.E.C.).
²⁰ Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (N.P.d.l.O., M.S.).

PMID: 34455823
PMCID: PMC8607902
DOI: 10.1161/STROKEAHA.121.034883

Abstract

Background and purpose: We evaluated whether stroke severity, functional outcome, and mortality are different in patients with ischemic stroke with or without coronavirus disease 2019 (COVID-19) infection.

Methods: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had an acute ischemic stroke within 48 hours and a previous modified Rankin Scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, National Institutes of Health Stroke Scale score, rate of reperfusion therapies, logistics, and metrics. Primary end point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariable analyses.

Results: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men) and 91 (13%) had COVID-19 infection. Median baseline National Institutes of Health Stroke Scale score was higher in patients with COVID-19 compared with patients without COVID-19 (8 [3-18] versus 6 [2-14], P=0.049). Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariable logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among patients with COVID-19 and 16.1% in the non-COVID-19 group. In the multivariable logistic regression analysis, COVID-19 infection was a risk factor for mortality (hazard ratio, 3.14 [95% CI, 2.10-4.71]; P<0.001).

Conclusions: Patients with ischemic stroke and COVID-19 infection have more severe strokes and a higher mortality than patients with stroke without COVID-19 infection. However, functional outcome is comparable in both groups.

Keywords: cerebrovascular disease; coronavirus; pandemics; prognosis; reperfusion; stroke; thrombectomy.

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Figures

**Figure 1.**
Scores on the modified Rankin Scale at 3 mo according to the coronavirus disease 2019 (COVID-19) infection status.

**Figure 2.**
Kaplan-Meier survival curve for mortality at 3 mo according to the coronavirus disease 2019 (COVID-19) infection status.

See this image and copyright information in PMC

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Impact of COVID-19 Infection on the Outcome of Patients With Ischemic Stroke

Affiliations

Impact of COVID-19 Infection on the Outcome of Patients With Ischemic Stroke

Authors

Affiliations

Abstract

Figures

References

Publication types

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LinkOut - more resources

Full Text Sources

Medical