Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

Abstract

<b><i>Introduction:</i></b> COVID-19 was found to be associated with an increased risk of stroke. This study aimed to compare characteristics, management, and outcomes of hospitalized stroke patients with or without a hospital diagnosis of CO­VID-19 at a nationwide scale. <b><i>Methods:</i></b> This is a cross-sectional study on all French hospitals covering the entire French population using the French national hospital discharge databases (<i>Programme de Médicalisation des Systèmes d’Information</i>, included in the <i>Système National des Données de Santé</i>). All patients hospitalized for stroke between 1 January and 14 June 2020 in France were selected. A diagnosis of COVID-19 was searched for during the index hospitalization for stroke or in a prior hospitalization that had occurred after 1 January 2020. <b><i>Results:</i></b> Among the 56,195 patients hospitalized for stroke, 800 (1.4%) had a concomitant COVID-19 diagnosis. Inhospital case-fatality rates were higher in stroke patients with COVID-19, particularly for patients with a primary diagnosis of COVID-19 (33.2%), as compared to patients hospitalized for stroke without CO­VID-19 diagnosis (14.1%). Similar findings were observed for 3-month case-fatality rates adjusted for age and sex that reached 41.7% in patients hospitalized for stroke with a concomitant primary diagnosis of COVID-19 versus 20.0% in strokes without COVID-19. <b><i>Conclusion:</i></b> Patients hospitalized for stroke with a concomitant COVID-19 diagnosis had a higher inhospital and 3 months case-fatality rates compared to patients hospitalized for stroke without a COVID-19 diagnosis. Further research is needed to better understand the excess of mortality related to these cases.

Impact of the first COVID-19 pandemic peak and lockdown on the interventional management of carotid artery stenosis in France

“…However, a sensitivity analysis where symptomatic stenosis was defined as the presence of an IS or TIA coded as primary diagnosis on the first unit of the carotid intervention stay or coded in previous stays in 60 days before the carotid intervention stay led to similar results. Moreover, the identification of stroke and TIA in the PMSI by ICD-10 codes was previously validated and this method has been used in published studies 26 , 27 , 28 . Second, the results concerning TFCAS must be interpreted with caution because of the low number performed annually in France.…”

The Potential Role of Gender in the Incidence, Management, and Outcomes of Stroke in Patients Suffering From COVID-19: A Brief Review

“…Data from the Global COVID-19 stroke registry comprising 853 stroke/COVID cases from a total of 15,128 strokes showed that apart from the male predominance among stroke/COVID patients mentioned before, male patients more frequently underwent endovascular therapies (58% among the endovascular-therapies-only patients with COVID-19 vs. 48.5% among controls, p-value <0.001) [ 24 ]. Likewise, in the aforementioned French study by Gabet et al, men underwent MT more frequently than women (66% vs. 48%, respectively, p=0.02) [ 22 ]. Finally, in a European multi-center cohort study conducted between March 1, 2020, and May 5, 2020, MT registry of 93 stroke/COVID patients (out of 855 total stroke patients who received MT) showed a higher representation of males in this cohort (67.7%), without, however, including any form of comparison to contemporary or historical controls [ 23 ].…”

“…To explore differences in gender-specific frequencies of stroke in patients with COVID-19, we assessed evidence from studies in which researchers compared cohorts of patients with stroke/COVID to properly matched either (i) historical cohorts, i.e., pre-pandemic stroke patients of the previous year(s) [ 14 , 17 , 20 ], and/or (ii) contemporary cohorts of patients with stroke but no COVID-19 [ 18 , 19 , 21 , 22 ]. Harrison et al performed a retrospective cohort study using electronic records from 50 healthcare organizations in the USA.…”

“…This emphasizes the need for further research to understand the excess mortality associated with these cases. The study found no gender difference in the occurrence of the combination of stroke and COVID-19 [ 22 ]. In a second French study of the impact of the COVID-19 pandemic on myocardial infarction and stroke hospitalizations, comparing data from 2019 to the period surrounding the 2020 nationwide study, significant male predominance was observed.…”

“…These data do not lead to a unanimous conclusion. In particular, studies from single countries, such as those from the USA [ 14 , 17 - 19 ] and one from France [ 22 ], exhibited no gender difference in the frequency of stroke/COVID. It appears intriguing to explain how another French study [ 21 ], with enrollment during a similar time period and recruitment of cases from the same electronic national database, yielded different results (i.e., a male predominance).…”