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Case Reports
. 2021 Nov;28(11):1236-1250.
doi: 10.1111/acem.14389. Epub 2021 Sep 29.

A case-control analysis of stroke in COVID-19 patients: Results of unusual manifestations of COVID-19-study 11

Eric Jorge García-Lamberechts  1 , Òscar Miró  2 , Marcos Fragiel  1 , Pere Llorens  3 , Sònia Jiménez  2 , Pascual Piñera  4 , Guillermo Burillo-Putze  5 , Alfonso Martín  6 , Francisco Javier Martín-Sánchez  1 , Javier Jacob  7 , Aitor Alquézar-Arbé  8 , Laura Ejarque Martínez  9 , Belén Rodríguez Miranda  10 , Martín Ruiz Grinspan  11 , María Jesús Domínguez  12 , Francisco Javier Teigell Muñoz  13 , Sara Gayoso Martín  14 , Ángel García García  15 , Marta Iglesias Vela  16 , Virginia Carbajosa  17 , Manuel Salido Mota  18 , María José Marchena González  19 , Carmen Agüera Urbano  20 , Jesus Porta-Etessam  21 , Elpidio Calvo  22 , Juan González Del Castillo  1 ; Spanish Investigators on Emergency Situations TeAm (SIESTA) network
Affiliations
Case Reports

A case-control analysis of stroke in COVID-19 patients: Results of unusual manifestations of COVID-19-study 11

Eric Jorge García-Lamberechts et al. Acad Emerg Med. 2021 Nov.

Abstract

Objective: We investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID-19 seen in emergency departments (EDs) before hospitalization.

Methods: We retrospectively reviewed all COVID-19 patients diagnosed with stroke during the COVID-19 outbreak in 62 Spanish EDs. We formed two control groups: COVID-19 patients without stroke (control A) and non-COVID-19 patients with stroke (control B). We compared disease characteristics and four outcomes between cases and controls.

Results: We identified 147 strokes in 74,814 patients with COVID-19 seen in EDs (1.96‰, 95% confidence interval [CI] = 1.66‰ to 2.31‰), being lower than in non-COVID-19 patients (6,541/1,388,879, 4.71‰, 95% CI = 4.60‰ to 4.83‰; odds ratio [OR] = 0.42, 95% CI = 0.35 to 0.49). The estimated that standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID-19 and non-COVID-19 individuals, respectively (OR = 0.93 for COVID patients, 95% CI = 0.87 to 0.99). Baseline characteristics associated with a higher risk of stroke in COVID-19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented with confusion, decreased consciousness, and syncope and higher D-dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and intensive care unit (ICU) admission rates (but not mortality) than COVID-19 controls without stroke (OR = 3.41, 95% CI = 1.27 to 9.16; and OR = 3.79, 95% CI = 1.69 to 8.50, respectively) and longer hospitalization and greater in-hospital mortality than stroke controls without COVID-19 (OR = 1.55, 95% CI = 1.24 to 1.94; and OR = 1.77, 95% CI = 1.37 to 2.30, respectively).

Conclusions: The incidence of stroke in COVID-19 patients presenting to EDs was lower than that in the non-COVID-19 reference sample. COVID-19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke and longer hospitalization and greater in-hospital mortality than non-COVID-19 patients with stroke.

Keywords: COVID-19; SARS-Cov-2; cerebrovascular disease; clinical characteristics; incidence; outcome; risk factors; stroke.

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Conflict of interest statement

The authors have no potential conflicts to disclose.

Figures

FIGURE 1
FIGURE 1
Study design and patient inclusion flow chart.
FIGURE 2
FIGURE 2
Outcomes of patients with COVID‐19 and stroke compared with COVID‐19 controls without stroke (control group A) and with stroke controls without COVID‐19 (control group B).
See this image and copyright information in PMC

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References

    1. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77 (6):683. - PMC - PubMed
    1. Cowan LT, Lutsey PL, Pankow JS, Matsushita K, Ishigami J, Lakshminarayan K. Inpatient and outpatient infection as a trigger of cardiovascular disease: the ARIC study. J Am Heart Assoc. 2018;7:e009683. - PMC - PubMed
    1. Madjid M, Safavi‐Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020;5 (7):831. - PubMed
    1. Boehme AK, Luna J, Kulick ER, Kamel H, Elkind MS. Influenza‐like illness as a trigger for ischemic stroke. Ann Clin Transl Neurol. 2018;5:456‐463. - PMC - PubMed
    1. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID‐19 pneumonia ‐ a systematic review, meta‐analysis, and meta‐regression. Diabetes Metab Syndr. 2020;14:395‐403. - PMC - PubMed

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