Comparative Functional Outcomes for Ischemic Stroke Patients with and without COVID-19

Abstract

Background: COVID-19, primarily a respiratory illness caused by SARS-CoV-2, is associated with vascular complications like ischemia due to endothelial injury, hypercoagulability, and inflammation. This study examines how COVID-19 affects functional outcomes of ischemic stroke patients. Methods: Ischemic stroke patients admitted to our Joint Commission-certified primary stroke center were retrospectively analyzed from March 1, 2020, to March 1, 2022. A subgroup analysis was conducted for patients during the vaccination period (April 14, 2021, to March 1, 2022). Patients were included if they were ≥18 years old and had a stroke on admission or during hospitalization. Univariate and multivariable analyses were used, with a significance threshold of p\u3c 0.05. Results: Out of 1,171 patients, those who tested positive for COVID-19 had significantly worse outcomes. Demographics, clinical data, and outcomes are found in Table 1. COVID-19 Positive patients experienced fewer days between stroke and death (4 days vs. 25 days, p=0.047), higher modified Rankin Scale (mRS) scores at discharge (3 vs. 1, p=0.001), and increased rates of altered consciousness (41.46% vs. 21.86%, p=0.03). In the vaccination period subgroup, COVID-positive patients had fewer days from stroke to death (4 days vs. 42 days, p=0.047), worse mRS scores (3 vs. 1, p=0.009), longer delays in discharge placement (0 vs. 1 day, p=0.020), and higher rates of altered consciousness (57.89% vs. 23.71%, p=0.001). Additionally, COVID-negative patients were more likely to be discharged home (49.52% vs. 36.84%, p=0.021). Multivariable analysis identified higher NIHSS at admission (OR: 1.028 [1.003–1.053], p=0.027), older age (OR: 1.027 [1.011–1.045], p=0.001), and a history of diabetes (OR: 1.596 [1.056–2.413], p=0.027) as increased mortality risks. Discussion & Conclusion: COVID-19 is associated with worse recovery outcomes and discharge delays for ischemic stroke patients compared to those without COVID-19. Further research is needed to explore these differences and their implications for stroke management amid the ongoing global health crisis