Impact of COVID-19 infection on the outcome of patients with ischemic stroke

Background and Aims: We evaluated whether stroke severity, functional outcome and mortality are different in patients with ischemic stroke with or without COVID-19 infection. Methods: A prospective, observational, multicentre cohort study in Catalonia, Spain. Recruitment was consecutive from mid-March to mid-May 2020. Patients had had an acute ischemic stroke within 48 hours and a previous modified Rankin scale (mRS) score of 0 to 3. We collected demographic data, vascular risk factors, prior mRS score, NIHSS score, rate of reperfusion therapies, logistics and metrics. Primary end-point was functional outcome at 3 months. Favourable outcome was defined depending on the previous mRS score. Secondary outcome was mortality at 3 months. We performed mRS shift and multivariate analyses. Results: We evaluated 701 patients (mean age 72.3±13.3 years, 60.5% men), and 91 (13%) had COVID-19 infection. Median baseline NIHSS score was higher in COVID-19 patients compared to patients without COVID-19 [8 (3-18) vs 6 (2-14), p=0.049)]. Proportion of patients with a favourable functional outcome was 33.7% in the COVID-19 and 47% in the non-COVID-19 group. However, after a multivariate logistic regression analysis, COVID-19 infection did not increase the probability of unfavourable functional outcome. Mortality rate was 39.3% among COVID-19 patients and 16.1% in the non-COVID-19 group. In the multivariate logistic regression analysis, COVID-19 infection was a risk factor for mortality (HR 3.14 (95% CI, 2.10-4.71;p<0.001). Conclusions: Patients with ischemic stroke and COVID-19 infection have more severe strokes and higher mortality than stroke patients without COVID-19 infection. However, functional outcome is comparable in both groups.