Melissa Bailey, MD

Sluis WM, Linschoten M, Buijs JE, Biesbroek JM, den Hertog HM, Ribers T, Nieuwkamp DJ, van Houwelingen RC, Dias A, van Uden IWM, et al. Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort Study. Stroke. 2021;52:3978–3986.

Stroke occurrence in COVID-19 patients has been widely observed, but our understanding of the incidence and outcomes associated with stroke in those with COVID-19 is still under investigation. The association between COVID-19 and thromboembolic events has been well established, and studies have reported varying incidences of ischemic stroke associated with this disease. However, few studies have analyzed the association between ischemic stroke and other cardiovascular risk factors in those with COVID-19. Sluis and colleagues investigated the incidence, associated risk factors, and outcomes in hospitalized patients in order to add to the growing body of literature regarding stroke and COVID-19.

This study used the CAPACITY-COVID patient registry to analyze data from 16 Dutch hospitals regarding patients hospitalized with COVID-19 from March to August of 2020. Information such as patients’ neurovascular history, factors associated with ischemic stroke while hospitalized (such as vascular risk factors, stroke etiology, stroke severity, and outcomes), and occurrence of cardiac or thromboembolic events were included in a substudy called STROCORNA. Of the 2147 patients included in the registry, 38 (1.8%) had an ischemic stroke while hospitalized, but the incidence was higher in those who were in an intensive care unit (2.7%). ICU patients with stroke had more thromboembolic events and more severe strokes than those not treated in an ICU (median ICU NIHSS 22 vs. ward NIHSS 5). Patients who had strokes were older, had a lower BMI, and had higher platelet counts than those who did not but had similar cardiovascular comorbidities. The majority of stroke etiology was either cardio-embolism (28.9%) or undetermined (47.4%). The time between COVID-19 diagnosis and stroke diagnosis was a median of 14 days. Patients with ischemic stroke were more likely to have concurrent pulmonary embolism and had higher in-hospital mortality.

This study found a similar incidence of ischemic stroke in patients hospitalized with COVID-19 as other cohort studies and adds to the body of evidence supporting an increased risk of stroke in those with COVID-19. Interestingly, this study did not find patients with stroke to have more cardiovascular risk factors than those without stroke. The authors attribute this to the possibility that COVID-19 infection itself or medical complications during hospitalization led to the increased stroke rather than traditional risk factors or that those with greater cardiovascular risk factors may have not survived to be in a hospital setting. One limitation of this study was that the cohort studied included only hospitalized patients and cannot be generalized to overall stroke incidence in COVID-19 patients. Additionally, data from this study was obtained from early in the pandemic; treatments of COVID-19 since that time have changed and so may have stroke incidence in hospitalized patients.