Increased stroke severity and mortality in patients with SARS-CoV-2 infection: An analysis from the N3C database

• Published in: Journal of stroke and cerebrovascular diseases 2023-03, Vol.32 (3), p.106987-106987, Article 106987
• Main Authors: Narrett, Jackson A, Mallawaarachchi, Indika, Aldridge, Chad M., Assefa, Ethan D, Patel, Arti, Loomba, Johanna J, Ratcliffe, Sarah, Sadan, Ofer, Monteith, Teshamae, Worrall, Bradford B, Brown, Donald E, Johnston, Karen C, Southerland, Andrew M
• Format: Article
• Language: English
• Subjects: COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 Testing; Hemorrhagic stroke; Hemorrhagic Stroke - diagnosis; Hemorrhagic Stroke - epidemiology; Hemorrhagic Stroke - therapy; Humans; Ischemic stroke; Ischemic Stroke - diagnosis; Ischemic Stroke - epidemiology; Ischemic Stroke - therapy; NIHSS; Pandemics; Retrospective Studies; SARS-CoV-2; Stroke; Stroke - diagnosis; Stroke - epidemiology; Stroke - therapy; United States - epidemiology
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2023.106987

Studies from early in the COVID-19 pandemic showed that patients with ischemic stroke and concurrent SARS-CoV-2 infection had increased stroke severity. We aimed to test the hypothesis that this association persisted throughout the first year of the pandemic and that a similar increase in stroke severity was present in patients with hemorrhagic stroke. Using the National Institute of Health National COVID Cohort Collaborative (N3C) database, we identified a cohort of patients with stroke hospitalized in the United States between March 1, 2020 and February 28, 2021. We propensity score matched patients with concurrent stroke and SARS-COV-2 infection and available NIH Stroke Scale (NIHSS) scores to all other patients with stroke in a 1:3 ratio. Nearest neighbor matching with a caliper of 0.25 was used for most factors and exact matching was used for race/ethnicity and site. We modeled stroke severity as measured by admission NIHSS and the outcomes of death and length of stay. We also explored the temporal relationship between time of SARS-COV-2 diagnosis and incidence of stroke. Our query identified 43,295 patients hospitalized with ischemic stroke (5765 with SARS-COV-2, 37,530 without) and 18,107 patients hospitalized with hemorrhagic stroke (2114 with SARS-COV-2, 15,993 without). Analysis of our propensity matched cohort revealed that stroke patients with concurrent SARS-COV-2 had increased NIHSS (Ischemic stroke: IRR=1.43, 95% CI:1.33–1.52, p