Stroke tied to higher death risk in hospitalized COVID-19 patients

Patients hospitalized with COVID-19 are more likely to die or have critical illness if they also have a stroke during hospitalization, according to a large dataset from the COVID-19 CVD Registry launched by AHA.

In addition, the overall rate of ischaemic stroke was 0.75 percent in this large cohort of 21,073 hospitalized COVID-19 patients.

“This is lower than reported previously but still higher than that reported after other infectious conditions like influenza,” said lead investigator Dr Saate Shakil from the University of Washington, Seattle, Washington, US, during the virtual ISC 2021. Estimates of ischaemic stroke risk ranged from 0.9 to 2.8 percent in previous studies, which Shakil noted were mostly single-centre studies and none involved a cohort as large as the current one.

The investigators found that patients who developed an ischaemic stroke were more likely to have comorbidities that are known risk factors for stroke, including hypertension (80 percent vs 58 percent), diabetes (44 percent vs 35.3 percent), prior cerebrovascular disease (22 percent vs 13 percent), and atrial fibrillation (18 percent vs 9 percent), compared with patients who did not have a stroke. [ISC 2021, abstract LB12]

“These findings suggest that COVID-19 may increase the risk for stroke, though the exact mechanism for this is still unknown,” said Shakil. “As the pandemic continues, we are finding that coronavirus is not just a respiratory illness, but a vascular disease that can affect many organ systems.”

Older age (mean age 65 vs 61 years) and being male (63 percent vs 54 percent) were also associated with a higher risk of ischaemic stroke among these patients.

Of note, clinical outcomes were significantly worse for patients who developed an ischaemic stroke during hospitalization for COVID-19 compare with those who did not. Patients with stroke were more than twice as likely to die (37 percent vs 16 percent) or to be critically ill than those without a stroke. The rates of ICU admission, mechanical ventilation, and incident renal replacement therapy were also higher in those with an ischaemic stroke vs those without.  

Furthermore, patients with stroke stayed in hospital about twice as long as those without (mean, 22 vs 10 days). 

Although many patients eventually recovered and were discharged, there may be long-term effects from COVID-19 which are not limited only to the period of hospitalization, pointed out ISC chair Dr Louise McCullough from the University of Texas Health Science Center at Houston, Texas, US.

“For the millions who have recovered from it, what are the long-term implications for repeat events, dementia, and other neurological issues over the next decades,” she said. “Even if COVID completely disappears next year, it’s never going to disappear because of the sheer number of people it has touched and affected.”

Large registry like this will provide more data from longer follow-up and help answer these questions, she suggested.