Coronavirus Disease 2019 in Patients With Prior Ischemic Stroke

Krishna Nalleballe; Suman Siddamreddy; Sen Sheng; Vasuki Dandu; Narenraj Arulprakash; Sukanthi Kovvuru; Mudassar Kamran; Madhu Jasti; Sanjeeva Onteddu

doi:10.7759/cureus.10231

Coronavirus Disease 2019 in Patients With Prior Ischemic Stroke

Cureus. 2020 Sep 3;12(9):e10231. doi: 10.7759/cureus.10231.

Authors

Krishna Nalleballe¹, Suman Siddamreddy², Sen Sheng¹, Vasuki Dandu³, Narenraj Arulprakash¹, Sukanthi Kovvuru¹, Mudassar Kamran⁴, Madhu Jasti⁵, Sanjeeva Onteddu¹

Affiliations

¹ Neurology, University of Arkansas for Medical Sciences, Little Rock, USA.
² Internal Medicine, Baptist Health Medical Center, Little Rock, USA.
³ Neurology, Baptist Health Medical Center, Little Rock, USA.
⁴ Radiology, University of Arkansas for Medical Sciences, Little Rock, USA.
⁵ Neurology, University of Maryland, Glen Burnie, USA.

Abstract

Background: It is uncertain if patients with prior ischemic stroke are vulnerable to coronavirus disease 2019 (COVID-19) and its complications.

Methods: We used TriNetX, a global health collaborative clinical research platform with a large global COVID-19 database. COVID-19 infection was identified with a positive lab value for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and related ribonucleic acid (RNA).

Findings: A total of 604,258 patients with history of ischemic stroke were identified, of which 891 patients (study cohort) were diagnosed with COVID-19. A control cohort with 32,136 patients diagnosed with COVID-19 after January 20^th 2020 without a history of ischemic stroke were identified. A comparison between study cohort and control cohort showed patients with prior history of stroke (study cohort) were older (69.5 vs 47.8; p<0.0001) and had more comorbidities contributing to worse clinical outcomes. After propensity matching for demographic variables and comorbidities, only rate of hospitalization (287 vs 231; p=0.0035) and need for critical care services (85 vs 55; p=0.0082) remained statistically significant while intubation (51 vs 43; p=0.39) and death (119 vs 115; p=0.77) showed trends towards worse outcomes but were not statistically significant. Interpretation: Patients with history of ischemic stroke tend to be significantly older with several comorbid conditions contributing to worse clinical outcomes after COVID-19, which makes them a vulnerable population.

Keywords: covid 19; stroke.