A case-control analysis of stroke in Covid-19 patients: Results of Unusual Manifestations of Covid-19-Study 11.

Jorge García-Lamberechts, Eric; Miró, Òscar; Fragiel, Marcos; Llorens, Pere; Jiménez, Sònia; Piñera, Pascual; Burillo, Guillermo; Martín, Alfonso; Martín-Sánchez, Francisco Javier; Jacob, Javier; Alquézar-Arbé, Aitor; Ejarque Martínez, Laura; Rodríguez Miranda, Belén; Ruiz Grinspan, Martín; Domínguez, María Jesús; Teigell Muñoz, Francisco Javier; Gayoso Martín, Sara; García García, Angel; Iglesias Vela, Marta; Carbajosa, Virginia; Salido, Manuel; Marchena González, María José; Agüera Urbano, Carmen; Porta-Etessam, Jesus; Calvo, Elpidio; Del Castillo, Juan González

OBJECTIVE We investigated the incidence, predictor variables, clinical characteristics, and stroke outcomes in patients with COVID-19 seen in emergency departments (EDs) before hospitalization. METHODS We retrospectively reviewed all COVID-19 patients diagnosed with stroke during the COVID-19 outbreak in 62 Spanish EDs. We formed two control groups: COVID-19 patients without stroke (control A) and non-COVID-19 patients with stroke (Control B). We compared disease characteristics and 4 outcomes between cases and controls. RESULTS We identified 147 strokes in 74,814 patients with COVID-19 seen in EDs (1.96‰, 95%CI=1.66-2.31‰), being lower than in non-COVID-19 patients (6,541/1,388,879, 4.71‰, 95%CI=4.60-4.83‰; OR=0.42, 95%CI=0.35-0.49). The estimated standardized incidences of stroke per 100,000 individuals per year were 124 and 133 for COVID-19 and non-COVID-19 individuals, respectively (OR=0.93 for COVID patients, 95%CI=0.87-0.99). Baseline characteristics associated with a higher risk of stroke in COVID-19 patients were hypertension, diabetes mellitus, and previous cerebrovascular and coronary diseases. Clinically, these patients more frequently presented confusion, decreased consciousness and syncope and higher D-dimer concentrations and leukocyte count at ED arrival. After adjustment for age and sex, the case group had higher hospitalization and ICU admission rates (but not mortality) than COVID-19 controls without stroke (OR=3.41, 95%CI=1.27-9.16; and OR=3.79, 95%CI=1.69-8.50; respectively), and longer hospitalization and greater in-hospital mortality than stroke controls without COVID-19 (OR=1.55, 95%CI=1.24-1.94; and OR=1.77, 95%CI=1.37-2.30; respectively). CONCLUSIONS The incidence of stroke in COVID-19 patients presenting to EDs was lower than in the non-COVID-19 reference sample. COVID-19 patients with stroke had greater need for hospitalization and ICU admission than those without stroke, and longer hospitalization and greater in-hospital mortality than non-COVID-19 patients with stroke.