Increased in hospital mortality in stroke during the COVID-19 era and related factors

Background and Aims: The COVID-19 pandemic has had enormous implications for stroke care. We aim to analyze its impact in stroke outcomes and mortality in two comprehensive stroke centers (CSC) from the Catalonian network. Methods:We studied all stroke patients admitted during 2020 and compared them with the admissions of 2019. Clinical and functional outcomes (mRS at discharge, in-hospital complications and mortality) were analyzed. Related factors, including SARS-CoV-2 infection, were determined. Results: A total of 2674 stroke patients were admitted in 2020, and 2652 during 2019. A higher number of unknown-onset strokes (45% vs 40%, p<0.01), ASPECTS<7 (8.3% vs 5.7%, p=0.03) and longer time from symptoms-onset to hospital-admission (median: 337 vs. 272min, p<0.01) were detected during 2020. Conversely, no significant differences appeared in stroke code activation (61.5% vs 62.5%), stroke subtype (ICH 9.1% vs 8.9%), severity (median NIHSS: 4 vs 5), pre-morbid mRS (mRS<3 81.8% vs 80.2%) or other relevant clinical characteristics nor reperfusion treatments (23.8% vs 23.9%). In-hospital complications and discharge-mRS were similar. However, we observed higher inhospital mortality in 2020 (9.6 vs 6.6%, p<0.001). An adjusted regression model pointed pre-morbid mRS, baseline NIHSS, ASPECTS and inhospital complications (OR 1.26, 1.14, 0.87 and 1.38 respectively, p<0.01) as independent predictors of mortality. SARS-CoV-2 infection (3.7% of strokes in 2020) was not predictor of mortality;in fact, these patients showed similar outcomes than the remaining 2020 strokes. Conclusions: The increased in-hospital mortality detected in 2020 in our series may be due to pandemic-related delays in stroke detection and hospital arrival rather than the direct effect of COVID-19.