Strokes Linked to COVID-19 Appear More Dangerous

Stroke associated with SARS-CoV-2 infection appears to be more dangerous for patients relative to the baseline risk of morbidity and mortality from stroke, according to a study published earlier this month in a journal of the American Heart Association, Stroke.

Investigators used a global COVID-19 registry to examine outcomes among patients with COVID-19 and acute ischemic stroke (AIS) treated at 28 health care centers across 16 countries.

For comparison, the team used the Acute Stroke Registry and Analysis of Lausanne Registry, with outcomes spanning 2003 to 2019.

From January 27, 2020 to May 19, 2020, there were 174 patients hospitalized with COVID-19 and AIS. Each COVID-19 patient with AIS was matched and compared to a non-COVID-19 AIS patient based on a set of pre-specified factors including age, gender and stroke risk factors.

The final analysis included 330 patients total. Stroke severity was assessed with the National Institute of Health Stroke Scale, and stroke outcome was qualified using the modified Rankin score. When AIS patients with COVID-19 were compared to non-COVID-19 patients:

• COVID-19 patients had more severe strokes (median stroke scale score of 10 vs. 6, respectively)
• COVID-19 patients had higher risk for severe disability following stroke (median rankin score 4 vs. 2, respectively)
• COVID-19 patients were more likely to die of AIS.

“Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways,” study authors wrote.

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 to the non-COVID-19 cohort may explain the worse outcomes. The broad, multi-system 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."