Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States

• Type of Material: Article
• Authors: Adam de Havenon, University of Utah; John P. Ney, Boston University; Brian Callaghan, University of Michigan; Alen Delic, University of Utah; Samuel Hohmann, Vizient Inc; Ernie Shippey, Vizient Inc; Gregory Esper, Emory University; Eric Stulberg, University of Utah; David Tirschwell, University of Washington; Jennifer Frontera, New York University; Shadi Yaghi, New York University; Mohammad Anadani, Washington University in St. Louis; Jennifer J. Majersik, University of Utah
• Language: English
• Date: 2021-02-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105535
• Title of Journal or Parent Work: Journal of Stroke & Cerebrovascular Diseases
• Volume: 30
• Issue: 2
• Grant/Funding Information: Dr. de Havenon is supported by NIH-NINDS K23NS105924. The research reported in this publication was supported (in part or in full) by the Utah Stimulating Access to Research in Residency Transition Scholar (StARRTS) under Award Number 1R38HL143605-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: Outcome; Epidemiology; Ischemic stroke; COVID-19; Neurology/cerebrovascular disease
• Research Categories: Biology, Neuroscience; Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Biology, Virology; Health Sciences, Epidemiology

Abstract

Background Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes. Methods We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW). Results In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p<0.05). Black and Hispanic patients accounted for 21.7% and 7.4% of IS controls, respectively, but 33.7% and 18.5% of IS-COVID (p<0.001). IS-COVID, versus IS controls, were less likely to receive alteplase (1.8% vs 5.6%, p<0.001), mechanical thrombectomy (4.4% vs. 6.7%, p<0.001), to have favorable discharge (33.9% vs. 66.4%, p<0.001), but more likely to die (30.4% vs. 6.5%, p<0.001). In the matched cohort of patients with IS-COVID and IS-PNA, IS-COVID had a higher risk of death (IPW-weighted OR 1.56, 95% CI 1.33-1.82) and lower odds of favorable discharge (IPW-weighted OR 0.63, 95% CI 0.54-0.73).