tetano
Editor, Senior Moderator
Clin Neurol Neurosurg
. 2023 Sep 15;233:107982.
doi: 10.1016/j.clineuro.2023.107982. Online ahead of print. The effect of COVID-19 on treatment and outcomes following ischemic stroke: A national assessment
Jonathan Dallas[SUP] 1 [/SUP], Kristie Q Liu[SUP] 2 [/SUP], Talia A Wenger[SUP] 2 [/SUP], Michelle Lin[SUP] 3 [/SUP], Li Ding[SUP] 4 [/SUP], Frank J Attenello[SUP] 3 [/SUP], William J Mack[SUP] 3 [/SUP]
Affiliations
Introduction: COVID-19 has had innumerable impacts on the healthcare system, both by worsening patient illness and impeding effective and efficient care. Further, COVID-19 has been tied to increased rates of ischemic stroke, particularly among young patients. We utilized a national database to assess associations of COVID-19 with thrombectomy rates, mortality, and discharge disposition among stroke patients.
Methods: Patients were identified from the National Inpatient Sample (NIS, 2020). Inclusion criteria selected for adult ischemic stroke patients; those with venous thrombosis or unspecified cerebral infarction were excluded. Patients were stratified by presence or absence of COVID-19 diagnosis. Outcome variables included mechanical thrombectomy, in-hospital mortality, and discharge disposition. Additional patient demographics, hospital characteristics, and disease severity metrics were collected. Statistical analysis was performed via multivariable logistic regression and log-binary regression.
Results: 54,368 patients were included in the study; 2116 (3.89%) were diagnosed with COVID-19. COVID-19 was associated with lower rates of mechanical thrombectomy (OR 0.94, p < 0.0001), higher rates of in-hospital mortality (OR 1.14, p < 0.0001), and unfavorable discharge disposition (OR 1.08, p < 0.0001), even when controlling for illness severity. Other relationships, such as a male predominance among stroke patients with COVID-19, were also identified.
Conclusion: This study identified a relationship between COVID-19 diagnosis and worse outcomes for each metric assessed, including mechanical thrombectomy rates, in-hospital mortality, and discharge disposition. Several factors might underly this, ranging from systemic/multisystem inflammation and worsened disease severity to logistical barriers to treatment caused by COVID-19. Further research is needed to determine causality of these findings.
Keywords: COVID-19; Cerebral Infarction; Coronavirus; Stroke; Thrombectomy.
. 2023 Sep 15;233:107982.
doi: 10.1016/j.clineuro.2023.107982. Online ahead of print. The effect of COVID-19 on treatment and outcomes following ischemic stroke: A national assessment
Jonathan Dallas[SUP] 1 [/SUP], Kristie Q Liu[SUP] 2 [/SUP], Talia A Wenger[SUP] 2 [/SUP], Michelle Lin[SUP] 3 [/SUP], Li Ding[SUP] 4 [/SUP], Frank J Attenello[SUP] 3 [/SUP], William J Mack[SUP] 3 [/SUP]
Affiliations
- PMID: 37729801
- DOI: 10.1016/j.clineuro.2023.107982
Introduction: COVID-19 has had innumerable impacts on the healthcare system, both by worsening patient illness and impeding effective and efficient care. Further, COVID-19 has been tied to increased rates of ischemic stroke, particularly among young patients. We utilized a national database to assess associations of COVID-19 with thrombectomy rates, mortality, and discharge disposition among stroke patients.
Methods: Patients were identified from the National Inpatient Sample (NIS, 2020). Inclusion criteria selected for adult ischemic stroke patients; those with venous thrombosis or unspecified cerebral infarction were excluded. Patients were stratified by presence or absence of COVID-19 diagnosis. Outcome variables included mechanical thrombectomy, in-hospital mortality, and discharge disposition. Additional patient demographics, hospital characteristics, and disease severity metrics were collected. Statistical analysis was performed via multivariable logistic regression and log-binary regression.
Results: 54,368 patients were included in the study; 2116 (3.89%) were diagnosed with COVID-19. COVID-19 was associated with lower rates of mechanical thrombectomy (OR 0.94, p < 0.0001), higher rates of in-hospital mortality (OR 1.14, p < 0.0001), and unfavorable discharge disposition (OR 1.08, p < 0.0001), even when controlling for illness severity. Other relationships, such as a male predominance among stroke patients with COVID-19, were also identified.
Conclusion: This study identified a relationship between COVID-19 diagnosis and worse outcomes for each metric assessed, including mechanical thrombectomy rates, in-hospital mortality, and discharge disposition. Several factors might underly this, ranging from systemic/multisystem inflammation and worsened disease severity to logistical barriers to treatment caused by COVID-19. Further research is needed to determine causality of these findings.
Keywords: COVID-19; Cerebral Infarction; Coronavirus; Stroke; Thrombectomy.