Increased Incidence of In-Hospital Ischemic Stroke During SARS-CoV-2 Outbreak: A Single-Center Study

Abstract

Background: Meta-analyses of observational studies report a 1.1-1.7% pooled risk of stroke among patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring hospitalization, but consultations for stroke and reperfusion procedures have decreased during the outbreak that occurred during the first half of the year 2020. It is still unclear whether a true increase in the risk of stroke exists among patients with coronavirus disease 2019 . In-hospital ischemic stroke (IHIS) complicated the 0.04-0.06% of all admissions in the pre-COVID-19 era, but its incidence has not been assessed among inpatients with COVID-19. We aimed to compare IHIS incidence among patients with SARS-CoV-2 infection with that of inpatients with non-COVID-19 illnesses from the same outbreak period and from previous periods. Methods: This historical cohort study belongs to the COVID-19@Vallecas cohort. The incidence of IHIS was estimated for patients with SARS-CoV-2 hospitalized during March-April 2020 [COVID-19 cohort (CC)], for patients with non-COVID-19 medical illness hospitalized during the same outbreak period [2020 non-COVID-19 cohort (20NCC)], and for inpatients with non-COVID-19 illness admitted during March-April of the years 2016-2019 [historical non-COVID-19 cohort (HNCC)]. Unadjusted risk of IHIS was compared between the three cohorts, and adjusted incidence rate ratio (IRR) of IHIS between cohorts was obtained by means of Poisson regression.Results: Overall, 8126 inpatients were included in this study. Patients in the CC were younger and more commonly men than those from the HNCC and 20NCC. Absolute risk of IHIS was 0.05% for HNCC, 0.23% for 20NCC, and 0.36% for CC, (p = 0.004 for HNCC vs. CC). Cumulative incidence for IHIS by day nine after admission, with death as a competing risk, was 0.09% for HNCC, 0.23% for 20NCC, and 0.50% for CC. In an adjusted Poisson regression model with sex, age, needing of intensive care unit admission, and cohort (HNCC as reference) as covariates, COVID-19 was an independent predictor for IHIS (IRR 6.76, 95% confidence interval 1.66-27.54, p = 0.01). A nonsignificant increase in the risk of IHIS was observed for the 20NCC (IRR 5.62, 95% confidence interval 0.93-33.9, p = 0.06).Conclusions: SARS-CoV-2 outbreak was associated with an increase in the incidence of IHIS when compared with inpatients from a historical cohort. Viral infection itself may be related to the increased risk of IHIS among patients with COVID-19, but in view of our results from the 20NCC, it is likely that other factors, such as hospital saturation and overwhelming of health systems, may have played a role in the increased frequency of IHIS.

Increased risk of new‐onset cardiovascular disease after COVID‐19: A systematic review and meta‐analysis of 14 cohorts

“…Table 1 and Appendix Table present the baseline characteristics of the included studies, Appendix Table presents the potential confounding variables adjusted or matched in included cohorts, and Appendix Table presents the funding sources of included studies. Overall, participants were from nine countries, seven of 14 studies were conducted in the United States, 29,31–33,36–38 two in the United Kingdom, 11,35 two in Spain, 12,30 and the remaining three were in Sweden, 39 Netherlands, 40 and global (France, Germany, Italy, Singapore, U.S.), 34 respectively. With 69.6% were white people (interquartile range [IQR]: 55.7–74.3), and the median mean age was 48.8 years (IQR: 42.4–63.4).…”

“…Finally, the certainty of evidence was assessed and categorised as high, moderate, low, or very low. Overall, participants were from nine countries, seven of 14 studies were conducted in the United States, 29,[31][32][33][36][37][38] two in the United Kingdom, 11,35 two in Spain, 12,30 and the remaining three were in Sweden, 39 Netherlands, 40 and global (France, Germany, Italy, Singapore, U.S.), 34 respectively. With 69.6% were white people…”

“…Following the screening of titles and abstracts, 160 studies were identified as potentially eligible and underwent full-text review. Eventually, 14 studies, involving a total of 25,378,834 participants11,12,[29][30][31][32][33][34][35][36][37][38][39][40] proved eligible (Figure1). The list of excluded studies can be found in Appendix TableS4.…”