Acute Ischemic Stroke and COVID-19: An Analysis of 27 676 Patients

Adnan I. Qureshi, MD; William I. Baskett, BS; Wei Huang, MA; Daniel Shyu, BS; Danny Myers, PhD; Murugesan Raju, PhD; Iryna Lobanova, MD; M. Fareed K. Suri, MD; S. Hasan Naqvi, MD; Brandi R. French, MD; Farhan Siddiq, MD; Camilo R. Gomez, MD; Chi-Ren Shyu, PhD

Disclosures

Stroke. 2021;52(3):905-912. 

In This Article

Results

There were a total of 8163 patients with confirmed COVID-19 among 27 676 patients in the Cerner deidentified COVID-19 dataset; 103 (1.3%) patients developed acute ischemic stroke among 8163 patients with COVID-19. One hundred ninety-nine (1.0%) patients developed acute ischemic stroke among 19 513 patents in whom COVID-19 infection was not diagnosed. Of the 103 patients with confirmed COVID-19 and acute ischemic stroke, 94 received their COVID-19 diagnosis during the same encounter that they had acute ischemic stroke.

Comparison Between COVID-19 Patients With and Without Acute Ischemic Stroke

The mean age (years±standard deviation) of COVID-19 patients with acute ischemic stroke was higher compared with those without stroke (68.8±15.1 versus 54.4±20.3; P<0.0001). The proportion of Black people (44.7% versus 31.2%; P=0.003) was higher and that of Hispanic people (5.8% versus 20.6%; P=0.0002) was lower among COVID-19 patients with acute ischemic stroke compared with those without stroke (Table 1). The proportion of patients with hypertension (84.5% versus 48.2%; P<0.0001), diabetes (56.3% versus 30.2%; P<0.0001), hyperlipidemia (75.7% versus 33.3%; P<0.0001), atrial fibrillation (28.2% versus 10.1%; P<0.0001), and congestive heart failure (33.0% versus 12.7%; P<0.0001) was significantly higher among COVID-19 patients with acute ischemic stroke compared with those without stroke. The proportion of patients who developed cerebral edema (3.9% versus 0.4%; P<0.0001; Table 1), intracerebral hemorrhage (1.9% versus 0%), or myocardial infarction (10.7% versus 4.6%; P=0.003) was higher among COVID-19 patients with acute ischemic stroke compared with those without stroke. COVID-19 patients with acute ischemic stroke were more likely to develop acute kidney injury (50.5% versus 22.8%; P<0.0001), hepatic failure (3.9% versus 1.2%; P=0.02), and respiratory failure (52.4% versus 29.6%; P<0.0001) compared with those without stroke. There was no difference in the proportion of patients who developed pneumonia, pulmonary embolism, deep venous thrombosis, and cardiac arrest between the two groups.

The in-hospital mortality (19.4% versus 6.2%; P<0.0001) and discharge to destination other than home (62.1% versus 29.1%; P<0.0001) were significantly higher in COVID-19 patients with acute ischemic stroke compared with those without stroke (Table 2). In the multivariate model including all COVID-19 patients, acute ischemic stroke was associated with discharge to destination other than home or death (relative risk [RR], 2.1 [95% CI, 1.6–2.4]; P<0.0001). Other factors associated with discharge to destination other than home or death were age (compared with <35 years) of 35 to 54 years (RR, 1.3 [95% CI, 1.2–1.5]; P<0.0001), age of 55 to 70 years (RR, 2.0 [95% CI, 1.8–2.1]; P<0.0001), and age >70 years (RR, 2.6 [95% CI, 2.6–2.7]; P<0.0001), men (RR, 1.1 [95% CI, 1.1–1.2]; P=0.0003), Black race (RR, 1.1 [95% CI, 1.0–1.2]; P=0.005), Hispanic ethnicity (RR, 0.7 [95% CI, 0.6–0.8]; P<0.0001), diabetes (RR, 1.3 [95% CI, 1.2–1.4]; P<0.0001), atrial fibrillation (RR, 1.4 [95% CI, 1.2–1.5]; P<0.0001), and congestive heart failure (RR, 1.4 [95% CI, 1.3–1.5]; P<0.0001).

Comparison Between Acute Ischemic Stroke Patients With and Without COVID-19

The mean age (±standard deviation) of acute ischemic stroke patients with COVID-19 was similar compared with those without COVID-19 (68.8±15.1 versus 71.0±14.9; P=0.24). The proportion of Black people (44.7% versus 19.6%; P<0.0001) was higher and that of White people (35.9% versus 56.3%; P=0.0007) was lower among acute ischemic stroke patients with COVID-19 compared with those without COVID-19 (Table 1). The proportions of patients with hypertension, diabetes, hyperlipidemia, atrial fibrillation, myocardial infarction, and congestive heart failure among acute ischemic stroke patients with COVID-19 were similar compared with those without COVID-19. The proportions of patients who developed cerebral edema, intracerebral hemorrhage, pulmonary embolism, deep venous thrombosis, and cardiac arrest were similar between acute ischemic stroke patients with and without COVID-19 (Table 1). There was no difference in the proportions of patients who developed acute kidney injury, hepatic failure, respiratory failure, or pneumonia between the two groups. The proportions of patients who received intravenous thrombolysis (1.0% versus 1.0%; P=0.98) or mechanical thrombectomy (1.0% versus 1.0%; P=0.98) among acute ischemic stroke patients with COVID-19 were similar compared with those without COVID-19.

The in-hospital mortality among acute ischemic stroke patients with COVID-19 was similar compared with those without COVID-19 (19.4% versus 21.6%; P=0.66). There was a significantly higher rate of discharge to destination other than home among acute ischemic stroke patients with COVID-19 compared with those without COVID-19 (62.1% versus 48.2%; P=0.02; Table 2). In the multivariate model, COVID-19 (RR, 1.2 [95% CI, 1.0–1.3]; P=0.03) was associated with discharge to destination other than home or death in patients with acute ischemic stroke. Another factor associated with discharge to destination other than home or death was atrial fibrillation (RR, 1.2 [95% CI, 1.0–1.3]; P=0.014).

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