COVID-۱۹ Increases the Mortality Rate of Stroke: Is It True and What Are the Predictors?

Background and Aim: COVID-۱۹ pandemic has become a major challenging issue worldwide after its emergence in December ۲۰۱۹ from Wuhan China. Although the most common and significant complication is respiratory symptoms, reports of neurological features are increasing. Not only ischemic stroke could be a life-threatening complication of COVID-۱۹ infected patients, there are reports of ischemic stroke as a presenting feature of COVID-۱۹ as well.  The aim of this study was to determine the mortality rate and its predictor in patients with stroke and COVID-۱۹. Materials and Methods: We performed a retrospective study of stroke patients, who admitted to three referral hospitals in Tehran and Karaj, Iran, during the first ۳ months of the pandemic period, investigate the outcome including need to mechanical ventilation and death, and compare them to similar period in a year before COVID-۱۹. The predictors for final outcome of death was determined. Data were analyzed with SPSS ۱۸ version using T-test and Chi-square. The P value below ۰.۰۵ was considered statistically significant. Results: ۱۲۴ individuals with stroke were admitted in three centers within first three months of COVID-۱۹ pandemic. The diagnosis of COVID-۱۹ was documented in ۵۹ individuals (۴۷.۶%), including ۸ subjects with PCR and ۴۶ subjects with typical appearance of lung involvement in chest CT scan. The initial NIHSS was ۱۴.۲±۷.۴ and ۱۰.۷±۷.۹ in COVID positive and COVID negative patients (P=۰.۰۵۳). Mechanical ventilation was done in ۵۹.۳% and ۲۷.۴% of COVID positive and COVID negative patients (P=۰.۰۰۱). Final outcome of death, including during admission or after discharge, was observed in ۴۷.۵% and ۲۱.۰% of COVID positive and COVID negative patients (P=۰.۰۲۵). The predictors for death in COVID positive patients included hemorrhagic stroke (P=۰.۰۱۳), the stroke in territory of MCA or ICA (P=۰.۰۴۲), main vessel occlusion as the mechanism of stroke (P<۰.۰۰۱) and presence of atrial fibrillation (P<۰.۰۰۱). There was no difference between the frequency of these factors between COVID-۱۹ positive and COVID-۱۹ negative patients (P>۰.۰۵). One year before COVID-۱۹ and within the similar duration, the death was observed in ۳۶/۱۸۶ (۱۹.۴%) of stroke patients. The involvement of lungs were observed in ۱۶/۲۴ (۶۶.۷%) patients with outcome of death (P<۰.۰۰۱). Except for hemorrhagic stroke (P=۰.۰۰۲), the other predictors of death from stroke in COVID-۱۹ patients had no relationship with outcome of death. Conclusion: The mortality rate of stroke in COVID-positive patients is more than ۲ times compared to COVID-negative patients. The hemorrhagic stroke, large vessel occlusion and atrial fibrillation are the predictor of death in COVID-۱۹ patients. The mortality rate of stroke in patients without COVID-۱۹ is similar to the mortality rate of stroke one year before the emergence of COVID-۱۹.

کلیدواژه ها:

COVID-۱۹ infection ، Outcome ، Pandemics ، Stroke