Association Between Ischemic Stroke and COVID-19 in China: A Population-Based Retrospective Study

Minghuan Wang; Han Zhang; Yuqin He; Chuan Qin; Xingyuan Liu; Mingqian Liu; Yuhong Tang; Xiaohua Li; Guang Yang; Yingxin Tang; Gang Liang; Shabei Xu; Wei Wang

doi:10.3389/fmed.2021.792487

Association Between Ischemic Stroke and COVID-19 in China: A Population-Based Retrospective Study

Front Med (Lausanne). 2022 Feb 21:8:792487. doi: 10.3389/fmed.2021.792487. eCollection 2021.

Authors

Minghuan Wang¹, Han Zhang¹, Yuqin He¹, Chuan Qin¹, Xingyuan Liu², Mingqian Liu³, Yuhong Tang³, Xiaohua Li³, Guang Yang³, Yingxin Tang¹, Gang Liang², Shabei Xu¹, Wei Wang¹

Affiliations

¹ Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
² Information Center, Wuhan Municipal Health Commission, Wuhan, China.
³ Winning Health Technology Group Co. Ltd, Shanghai, China.

Abstract

Background and purpose: To investigate the effect of prior ischemic stroke on the outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19), and to describe the incidence, clinical features, and risk factors of acute ischemic stroke (AIS) following COVID-19.

Methods: In this population-based retrospective study, we included all the hospitalized positive patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020. Clinical data were extracted from administrative datasets coordinated by the Wuhan Health Commission. The propensity score matching and multivariate logistic regression analyses were used to adjust the confounding factors.

Results: There are 36,358 patients in the final cohort, in which 1,160 (3.2%) had a prior stroke. After adjusting for available baseline characteristics, patients with prior stroke had a higher proportion of severe and critical illness and mortality. We found for the first time that the premorbid modified Rankin Scale (MRS) grouping (odds ratio [OR] = 1.796 [95% CI 1.334-2.435], p < 0.001) and older age (OR = 1.905 [95% CI 1.211-3.046], p = 0.006) imparted increased risk of death. AIS following COVID-19 occurred in 124 (0.34%) cases, and patients with prior stroke had a much higher incidence of AIS (3.4%). Logistic regression analyses confirmed an association between the severity of COVID-19 with the incidence of AIS. COVID-19 patients with AIS had a significantly higher mortality compared with COVID-19 patients without stroke and AIS patients without COVID-19.

Conclusions: Coronavirus disease 2019 patients with prior stroke, especially those with the higher premorbid MRS or aged, have worse clinical outcomes. Furthermore, COVID-19 increases the incidence of AIS, and the incidence is positively associated with the severity of COVID-19.

Keywords: COVID-19; MRS; acute ischemic stroke; prior stroke; risk factors.