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Increased in hospital mortality in stroke during the COVID-19 era and related factors

2021; SAGE Publishing; Volume: 6; Linguagem: Inglês

2396-9881

Sandra Boned, Marta Rubiera, Atenas Bustamante, Matías Deck, Miguel Requena, Alessandro Elery Ramos, Marta Olivé‐Gadea, María Hernández‐Pérez, Marián Muchada, Álvaro García‐Tornel, Meritxell Gomis, Noelia Rodríguez‐Villatoro, Luis Rodríguez‐Esparragoza, M. Paré, Mar Lozano, David Rodríguez‐Luna, Jesús Juega, Jorge Pagola, Cecilia Molina, M. Millán, Marc Ribó, Natàlia Pérez de la Ossa,

Long-Term Effects of COVID-19

Background and Aims: The COVID-19 pandemic has had enormous implications for stroke care. We aim to analyze its impact in stroke outcomes and mortality in two comprehensive stroke centers (CSC) from the Catalonian network. Methods:We studied all stroke patients admitted during 2020 and compared them with the admissions of 2019. Clinical and functional outcomes (mRS at discharge, in-hospital complications and mortality) were analyzed. Related factors, including SARS-CoV-2 infection, were determined. Results: A total of 2674 stroke patients were admitted in 2020, and 2652 during 2019. A higher number of unknown-onset strokes (45% vs 40%, p<0.01), ASPECTS<7 (8.3% vs 5.7%, p=0.03) and longer time from symptoms-onset to hospital-admission (median: 337 vs. 272min, p<0.01) were detected during 2020. Conversely, no significant differences appeared in stroke code activation (61.5% vs 62.5%), stroke subtype (ICH 9.1% vs 8.9%), severity (median NIHSS: 4 vs 5), pre-morbid mRS (mRS<3 81.8% vs 80.2%) or other relevant clinical characteristics nor reperfusion treatments (23.8% vs 23.9%). In-hospital complications and discharge-mRS were similar. However, we observed higher inhospital mortality in 2020 (9.6 vs 6.6%, p<0.001). An adjusted regression model pointed pre-morbid mRS, baseline NIHSS, ASPECTS and inhospital complications (OR 1.26, 1.14, 0.87 and 1.38 respectively, p<0.01) as independent predictors of mortality. SARS-CoV-2 infection (3.7% of strokes in 2020) was not predictor of mortality;in fact, these patients showed similar outcomes than the remaining 2020 strokes. Conclusions: The increased in-hospital mortality detected in 2020 in our series may be due to pandemic-related delays in stroke detection and hospital arrival rather than the direct effect of COVID-19.