The impact of SARS-CoV-2 infection on the outcome of acute ischemic stroke—A retrospective cohort study

Abstract

Background Acute ischemic stroke (AIS) is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection (COVID-19), but the prognosis of these patients is poorly understood. Purpose To explore the impact of COVID-19 on neurological outcomes in AIS patients. Methods A comparative retrospective cohort study was conducted in 32 consecutive AIS patients with and 51 without COVID-19 between the 1st of March 2020 and 1st of May 2021. The evaluation was based on a detailed chart review for demographic data, medical history, stroke severity, cranial and vessel imaging results, laboratory parameters, COVID-19 severity, hospitalization time, in-hospital mortality, and functional deficits at discharge (modified Rankin Scale, mRS). Results COVID-19 AIS patients showed tendency to worse initial neurological deficit (NIHSS 9 (3–13) vs. 4 (2–10); p = 0.06), higher rate of large vessel occlusion (LVO; 13/32 vs. 14/51; p = 0.21), had prolonged hospitalization (19.4 ± 17.7 vs. 9.7 ± 7 days; p = 0.003), had lower chance of functional independence (mRS≤2) (12/32 vs. 32/51; p = 0.02) and showed higher in-hospital mortality (10/32 vs. 6/51; p = 0.02). In COVID-19 AIS patients, LVO was more common with COVID-19 pneumonia than without (55.6% vs. 23.1%; p = 0.139). Conclusion COVID-19-related AIS carries a worse prognosis. COVID-19 with pneumonia seems to be associated with a higher rate of LVO.

Impact and prevalence of comorbidities and complications on the severity of COVID-19 in association with age, gender, obesity, and pre-existing smoking: A meta-analysis

“…In this study, age was statistically significant (SMD = 0.62, 95 % CI: 0.43–0.82 of which OR = 3.06, 95 % CI: 2.18–4.40; I 2 = 97 %; p < 0.001) [ 14 – 25 , 27 – 46 ]. Of all articles included in this study, the mean age of patients with severe affection was higher than that of patients with non-severe affection, except for the studies of Takacs et al, 2023 and Xu et al, 2023 [ 36 , 41 ]. Patients’ pre-existing smoking status was positively correlated with severe coronavirus disease (OR = 1.33, 95 % CI: 1.01–1.75; I 2 = 67 %, P < 0.001) [ 15 , 18 – 20 , 23 – 26 , 31 , 32 , 34 , 35 , 39 , 43 – 46 ].…”

“…This risk is followed by chronic kidney disease (CKD), with an OR of 2.27 (95 % CI: 1.26–4.06]; I 2 = 96 %; P < 0.001) [ 15 , 18 , 19 , 22 , 24 , 26 – 35 , 37 , 38 , 42 , 44 , 45 ], hypertension with an OR of 2.22 (95% CI: 1.72–2.87; I 2 = 96 %; p < 0.001) [ 14 – 40 , 42 – 46 ] and coronary heart disease with an OR of 2.17 (95 % CI: 1.42–3.31; I 2 = 98 %; p < 0.001) [ 15 , 18 – 22 , 24 – 46 ]. Other significant judgment criteria for risk factors of the comorbidities involved in the severe form of COVID-19 included chronic obstructive pulmonary disease (COPD) (OR: 1.95, 95% CI: 1.22–3.09; I 2 =98%, p < 0.001) [ 14 , 15 , 19 – 23 , 25 – 28 , 30 – 32 , 34 – 36 , 38 – 42 , 44 , 45 ], diabetes mellitus (OR=1.81, 95% IC: 1.35–2.43; I 2 =97 %, p<0.001) [ 14 – 46 ], malignancy (OR=1.63, 95 % CI: 1.07–2.49; I 2 = 94 %; p < 0.001) [ 18 – 22 , 24 – 32 , 35 , 36 , 38 – 41 , 44 , 45 ...…”