Strokes Associated with COVID-19 May Be More Severe With Higher Mortality

As published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association, acute ischemic strokes (AIS) associated with COVID-19 are more severe, lead to worse functional outcomes, and are associated with higher mortality.

Researchers analyzed data from participants with COVID-19 and AIS who were treated at 28 health care centers in 16 countries this year. The data was compared with data from individuals without COVID-19 from the acute stroke registry and analysis of Lausanne (ASTRAL) registry. Researchers sought to determine the clinical characteristics and outcomes of people with COVID-19 and AIS.

In both groups, stroke severity was estimated with the National Institute of Health Stroke Scale (NIHSS), and stroke outcome was assessed by the modified Rankin score (mRS). When individuals with AIS and COVID-19 were compared with those without COVID-19, they had:
•    more severe strokes (median NIHSS score of 10 vs 6);   
•    a higher risk for severe disability following stroke (median mRS score 4 vs 2); 
•    higher rate of death from AIS.

Between January 27, 2020 to May 19, 2020, there were 174 participants hospitalized with COVID-19 and AIS. Each COVID-19 participant with AIS was matched and compared with nonCOVID-19 AIS participants based on a set of prespecified factors including age, gender, and stroke risk factors. The risk factors include hypertension, diabetes, atrial fibrillation, coronary artery disease, heart failure, cancer, previous stroke, smoking, obesity, and dyslipidemia. The final analysis included 330 participants total.  

The researchers noted there are several potential explanations for the relationship between COVID-19-associated strokes and increased stroke severity: “The increased stroke severity at admission in COVID-19-associated stroke patients compared with the nonCOVID-19 cohort may explain the worse outcomes. The broad, multisystem complications of COVID-19, including acute respiratory distress syndrome, cardiac arrhythmias, acute cardiac injury, shock, pulmonary embolism, cytokine release syndrome, and secondary infection, probably contribute further to the worse outcomes including higher mortality in these patients. … The association highlights the urgent need for studies aiming to uncover the underlying mechanisms and is relevant for prehospital stroke awareness and in-hospital acute stroke pathways during the current and future pandemics.”