Study Suggests Risk of In-Hospital Mortality from Stroke 42% Greater During Pandemic

Data comparing stroke-related admissions during the COVID-19 pandemic and prepandemic periods suggests patients hospitalized during the pandemic were at a significantly greater likelihood of death than those hospitalized prepandemic.

A meta-analysis of 455,073 stroke admissions, the study, which was presented at International Stroke Conference 2022, hospitalized stroke patients were at a 42% greater risk of mortality during the pandemic compared to their prepandemic counterparts.

“This largest meta-analysis to date on the subject found that hospitalized stroke patients, elderly or nonelderly, had nearly 40% higher risk of mortality during the COVID pandemic versus the pre-COVID era, more significantly in Europe,” said Akhil Jain, MD, Mercy Catholic Medical Center in Yeadon, PA, during his presentation at ISC 2022.

The stroke risk associated with COVID-19 has been the subject of discussion since the early days of the pandemic. With this in mind, Jain and a team of colleagues sought to provide an overview of the risk of stroke-related mortality among patients hospitalized during the pandemic compared to pre-pandemic periods. To do so, investigators designed their study of a meta-analysis of articles detailing stroke and stroke-related in-hospital mortality from the PubMed/Medline, SCOPUS, and EMBASE libraries.

For the purpose of analysis, random-effects modeling was used to calculate odds ratios for stroke-related in-hospital mortality. Investigators identified a total of 31 studies detailing 455,073 stroke admissions, with 365,253 occurring prior to the COVID-19 pandemic and 89,820 occurring during the pandemic. Investigators noted patients hospitalized with stroke prior to the pandemic had a mean age of 72 years and those hospitalized during the pandemic had a mean age of 70 years. Additionally, the cohorts had comparable distribution of males, prevalence of atrial fibrillation, and thrombolysis.

Results of the investigators' analyses suggested patients hospitalized during the pandemic were at a greater risk of mortality than those hospitalized prior to the pandemic (OR, 1.42 [95% CI, 1.06-1.92]; P =.018, I2=98.59). Subgroup analyses indicated risk of mortality was greater in study cohorts with a mean age greater than 70 years (OR, 1.48; P=.020) compared to those with a mean age of 70 years or fewer (OR, 1.27; P <.001).

When assessing risk in cross-continental subgroup analyses, results suggested a significantly greater increase in death was observed in Europe during the pandemic period compared with prepandemic period (OR, 1.31; P <.001) while nonsignificant increases were seen in Asia (OR, 1.13; P=.57), the US (OR, 1.59; P=.23), and Africa (OR, 1.20; P=.46).

Investigators pointed out subgroup analysis of 16 studies with 100-1000 participants demonstrated a significantly higher risk of in-hospital mortality during the pandemic versus prepandemic period (OR, 1.31), but studies with fewer than 100 or more than 1000 participants did not demonstrate any significantly difference.

This study, “Significantly Higher Odds of Mortality In Stroke-Related Admissions During COVID-19 Pandemic Versus Pre-COVID/Pandemic: A Meta-Analysis Of 455,073 Stroke Admissions,” was presented at ISC 2022.