UCL Study Gives Overview of Trends and Outcomes with COVID-19-Related Stroke

David Werring, PhD

Data from an analysis of coronavirus disease 2019 (COVID-19)-related stroke is giving clinicians an updated overview of predictors and outcomes for this patient population.

Results of the analysis, which included data from more than 1400 stroke patients, suggest having COVID-19 at stroke-onset was associated with more than double the rate of mortality of other stroke patients and also suggest patients of Asian descent might be more likely to experience COVID-19-associated strokes than other groups.

"Our findings suggest that in some people, COVID-19 may influence stroke risk through its effect on excessive blood clotting or inflammation, and may also influence the characteristics and outcome of the stroke, including greater severity with a higher chance of multiple large vessel blood clots,” said study investigator David Werring, PhD, professor at the University College of London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, in a statement.

With a knowledge gap related to characteristics and outcomes of stroke in patients with COVID-19, Werring and team of colleagues from the University College of London sought to provide clinicians with an updated overview of trends in this area. The (Service Evaluation of The Impact of COVID-19 On Stroke (SETICOS) project, which is currently being conducted in 13 stroke centers in England and Scotland, was designed to fill this knowledge gap.

Using data from SETICOS, investigators created a case-control study with patients admitted for stroke between March 9-July 5, 2020. From a search of this time period, investigators identified 86 patients with stroke and evidence of COVID-19 at time of onset. For their analysis, investigators compared the characteristics and outcomes of these patients to those of the 1384 stroke patients admitted during the same time period without evidence of COVID-19.

Of the 86 patients with strokes and COVID-19, 81 were ischemic strokes and 5 were intracerebral hemorrhages. This group had a median age of 74.5 (67-84) years, 54.7% were men, 71.6% were white, 9.5% were Black, and 17.6% were Asian.

Of the 1834 stroke patients in the control group, 1193 ischemic strokes and 191 were intracerebral hemorrhages. This group had a median age of 73 (61-82) years, 52.8% were men, 82.3% were white, 9.1% were black, and 7.3% were Asian.

In comparison to controls with ischemic stroke, those with ischemic stroke and COVID-19 were more likely to have multiple large vessel occlusions (17.9% vs 8.1%; P <.03), were more severe (median NIHSS, 8 vs 5; P <.002), were associated with higher D-dimer levels (P <.01) and were associated with more severe disability on discharge (median mRS, 4 vs 3; P <.0001) and inpatient death (19.8% vs 9.6%; P <.0001).

In regard to outcomes, 19.8% of ischemic strokes among COVID-19 patients resulted in death compared to 9.6% of patients in the control group (P <.00003). Additionally, investigators pointed out the recurrence of stroke during admission was very rare among those with COVID-19 (2.3% and the console group (1.0%).

"By comparing characteristics and outcomes of strokes experienced by people with and without COVID-19, we found that there were differences between the groups, suggesting that COVID-19 exerts an influence over the presentation of stroke,” added Richard Perry, PhD, neurologist at the UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, in the aforementioned statement.

This study “Characteristics and outcomes of COVID-19-associated stroke: a UK multicenter case-control study,” was published in the Journal of Neurology, Neurosurgery & Psychiatry.