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. 2023 Jul 8;12(14):4560.
doi: 10.3390/jcm12144560.

Impact of COVID-19 Diagnosis on Mortality in Patients with Ischemic Stroke Admitted during the 2020 Pandemic in Italy

Leonardo De Luca  1   2 , Paola D'Errigo  3 , Stefano Rosato  3 , Gabriella Badoni  3 , Barbara Giordani  4 , Gian Francesco Mureddu  5 , Andrea Tavilla  6 , Fulvia Seccareccia  3 , Giovanni Baglio  4
Affiliations

Impact of COVID-19 Diagnosis on Mortality in Patients with Ischemic Stroke Admitted during the 2020 Pandemic in Italy

Leonardo De Luca et al. J Clin Med. .

Abstract

Aims: The impact of the COVID-19 pandemic on the event rate of patients with ischemic stroke has been poorly investigated. We sought to evaluate the impact of the COVID-19 infection on mortality in patients with ischemic stroke admitted during the 2020 pandemic in Italy.

Methods: We analyzed a nationwide, comprehensive, and universal administrative database of patients who were admitted for ischemic stroke during and after the national lockdown for the COVID-19 infection in 2020, and the equivalent periods over the previous 5 years in Italy. The 2020 observed hospitalization and mortality rates of stroke patients with and without COVID-19 infection were compared with the expected rates, in accordance with the trend of the previous 5 years.

Results: During the period of observation, 300,890 hospitalizations for ischemic stroke occurred in Italy. In 2020, 41,302 stroke patients (1102 with concomitant COVID-19 infection) were admitted at 771 centers. The rate of admissions for ischemic stroke during the 2020 pandemic was markedly reduced compared with previous years (percentage change vs. 2015: -23.5). Based on the 5 year trend, the 2020 expected 30 day and 1 year mortality rates were 9.8% and 23.9%, respectively, and the observed incidence of death rates were 12.2% and 26.7%, respectively (both p < 0.001). After multiple corrections, higher rates of mortality were observed among patients admitted for stroke with a concomitant COVID-19 diagnosis.

Conclusions: During the COVID-19 pandemic in 2020 in Italy, the rate of hospitalizations for ischemic stroke was dramatically reduced, although both the 30 day and 1 year mortality rates increased compared with the previous 5 year trend.

Keywords: COVID-19; hospitalizations; mortality; national outbreak; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Expected (exp.) and observed (obs.) incidence of ischemic stroke admission during 2020 (11 March–31 December), over the equivalent periods in the previous 5 years in Italy (panel A), and by geographic region (panel B).
Figure 2
Figure 2
Expected (exp.) and observed (obs.) mortality rate at 1 year (in all ischemic stroke patients and in those without COVID-19 infection) during 2020 (11 March–31 December), over the equivalent periods in the previous 5 years in Italy, and by geographic region.
Figure 3
Figure 3
Cox-adjusted survival curves regarding the 1 year mortality rate of stroke patients, with or without a COVID-19 diagnosis, admitted in Italy during the pre-COVID-19 (11 March–31 December of 2015–2019), lockdown (LD; 11 March–3 May 2020), and post-lockdown (Post LD; 4 May–31 December 2020) periods.
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