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. 2024 May;31(5):e16221.
doi: 10.1111/ene.16221. Epub 2024 Jan 30.

Sex differences in acute stroke metrics and outcome dependent on COVID status

Lukas Mayer-Suess  1 , João Pedro Marto  2 , Davide Strambo  3 , George Ntaios  4 , Thanh Nguyen  5 , Stefan Kiechl  1   6 , Raimund Pechlaner  1 , Raul Nogueira  7 , Patrik Michel  3 , Michael Knoflach  1   6 ; Global COVID19 Stroke Registry
Affiliations

Sex differences in acute stroke metrics and outcome dependent on COVID status

Lukas Mayer-Suess et al. Eur J Neurol. 2024 May.

Abstract

Background and purpose: Biological sex is known to have an impact on quality metrics of acute stroke. We aimed to determine whether COVID positivity accentuates this effect and constitutes worse outcome.

Methods: The present analysis was based on the Global COVID-19 Stroke Registry, a retrospective, international, cohort study of consecutive ischemic stroke patients receiving intravenous thrombolysis and/or endovascular thrombectomy between 1 March 2020 and 30 June 2021. We investigated differences between the sexes in patient characteristics, acute stroke metrics as well as post-stroke outcome in COVID-positive and COVID-negative stroke patients undergoing acute revascularization procedures.

Results: A total of 15,128 patients from 106 centers were recorded in the Global COVID-19 Stroke Registry, 853 (5.6%) of whom were COVID-positive. Overall, COVID-positive individuals were treated significantly slower according to every acute stroke metric compared to COVID-negative patients. We were able to show that key quality indicators in acute stroke treatment were unfavorable for COVID-negative women compared to men (last-seen-well-to-door time + 11 min in women). Furthermore, COVID-negative women had worse 3-month outcomes (3-month modified Rankin Scale score [interquartile range] 3.0 [4.0] vs. 2.0 [3.0]; p < 0.01), even after adjusting for confounders. In COVID-positive individuals no such difference between the sexes, either in acute management metrics or in 3-month outcome, was seen.

Conclusion: Known sex-related differences in acute stroke management exist and extend to times of crisis. Nevertheless, if patients were COVID-19-positive at stroke onset, women and men were treated the same, which could be attributed to structured treatment pathways.

Keywords: COVID‐19; metrics; outcome; sex; stroke.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

FIGURE 1
FIGURE 1
Differences in treatment metrics of acute stroke management between COVID‐positive and COVID‐negative patients. LSW, last seen well.
FIGURE 2
FIGURE 2
Differences in treatment metrics of acute stroke management between female and male patients according to their COVID status. LSW, last seen well.
See this image and copyright information in PMC

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