Characteristics of a Diverse Cohort of Stroke Patients with SARS-CoV-2 and Outcome by Sex

Trifan, G.; Goldenberg, F.D.; Caprio, F.C.; Biller, J.; Schneck, M.; Khaja, A.; Terna, T.; Brorson, J.; Lazaridis, C.; Bulwa, Z.; Alvarado-Dyer, R.; Saleh-Velez, F.G.; Prabhakaran, S.; Liotta, E.M.; Batra, A.; Reish, N.J.; Ruland, S.; Teitcher, M.; Taylor, W.; De la Pena, P.; Conners, J.C.; Grewal, P.K.; Pinna, P.; Dafer, R.M.; Osteraas, N.D.; DaSilva, I.; Hall, J.P.; John, S.; Shafi, N.; Miller, K.; Moustafa, B.; Vargas, A.; Gorelick, P.B.; Testai, F.D.

BACKGROUND AND PURPOSE: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. To objective of this paper is to describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease and determine the role of sex on outcome. METHODS: This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage or median and interquartile range. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis. RESULTS: The study included 83 patients, 47% of which were Black, 28% Hispanics/Latinos, and 16% whites. Median age was 64 years. Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Compared with females, a higher proportion of males experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p=0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared with females, males had higher mortality (38% vs. 13%; p=0.02) and were less likely to be discharged home (12% vs. 33%; p=0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR=1.47, 95% CI=1.03-2.09). CONCLUSION: In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.