A research team led by Dr. Luciano A. Sposato found that approximately two in every 100 patients admitted to the hospital with COVID-19 will suffer a stroke and 35 percent will die as a result.
In younger patients, almost 50 percent had no other visible symptoms of the virus at the time of the stroke.
Since the beginning of the COVID-19 pandemic, researchers have been working to better understand and characterize the various symptoms of the disease. One of the most worrying symptoms is the development of large blood clots that can cause blockages in the arteries leading to stroke.
Researchers at Western University, led by Dr. Luciano Sposato, have been investigating the relationship between COVID-19 and stroke to better understand the disease. risk in these patients and helps in treatment planning.
In a new study published online in Neurology ®, the medical journal of the American Academy of Neurology, the research team reports that approximately two in every 100 patients admitted to the hospital with COVID-19 will suffer a stroke and 35 percent will die as a result of both conditions. The researchers reported that in the younger patients, almost 50 percent had no other visible symptoms of the virus at the time of stroke onset.
They also found that the interaction of older age, other chronic conditions, and the severity of COVID-19 respiratory symptoms was associated with one of the most telling findings of this study is that for patients under 50 years of age, many were completely asymptomatic. when they had a COVID-19-related stroke,” said Dr. Sposato, associate professor and the Kathleen & Dr. Henry Barnett Chair in Stroke Research at Western’s Schulich School of Medicine and Dentistry.
"This means that for these patients, the stroke was the first symptom of the disease."
Sposato says understanding the interaction between COVID-19 and stroke is important for treatment planning, especially in areas where COVID-19 is actively circulating in the community. “The take-home message here for healthcare providers is that if you are seeing a stroke patient, particularly those under 50 with large clots, you should think about COVID-19 as a potential cause even.” in the absence of respiratory symptoms,” Dr. Sposato said.
The research team completed a systemic review of published cases of COVID-19 and stroke and combined that data with 35 other unpublished cases from Canada, the United States and Iran. In total, the team examined 160 cases, considering both clinical characteristics and in-hospital mortality.
“COVID-19 has changed the stroke landscape around the world. "As stroke neurologists, we need a new mindset to be able to quickly diagnose and treat patients with COVID-19-related strokes," said Dr. Sebastian Fridman, assistant professor, Clinical Neurological Sciences at Schulich Medicine & Dentistry and first author. of the study.
Summary To investigate the hypothesis that strokes occurring in patients with COVID-19 have distinctive characteristics, we investigated stroke risk, clinical phenotypes, and outcomes in this population. Methods: We conducted a systematic search resulting in 10 studies reporting the frequency of stroke among patients with COVID-19, which were combined with an unpublished series from Canada. We applied random effects meta-analysis to estimate the proportion of stroke among COVID-19. We conducted an additional systematic search for case series of stroke in patients with COVID-19 (n = 125) and pooled these data with 35 unpublished cases from Canada, USA and Iran. We analyzed clinical characteristics and in-hospital mortality stratified by age groups (<50, 50-70, > 70 years). We applied cluster analysis to identify specific clinical phenotypes and their relationship with death. Results: The proportion of COVID-19 patients with stroke (1.8%, 95% CI 0.9-3.7%) and in-hospital mortality (34.4%, 95% CI 27.2-42.4%) It was extremely high . Mortality was 67% lower in patients <50 years compared to those >70 years (OR 0.33, 95% CI 0.12 to 0.94, P = 0.039). Large vessel occlusion was twice as common (46.9%) as previously reported and was high in all age groups, even in the absence of risk factors or comorbidities. A clinical phenotype characterized by older age, a higher burden of comorbidities, and severe respiratory symptoms of COVID-19 was associated with the highest in-hospital mortality (58.6%) and a 3-fold higher risk of death than the rest of the cohort. (OR 3.52; 95% CI: 1.53-8.09; p = 0.003). Conclusions: Stroke is relatively common among COVID-19 patients and has devastating consequences at all ages. The interaction of older age, comorbidities, and severity of COVID-19 respiratory symptoms is associated with extremely high mortality. |
Main results of the study
- 160 patients with COVID-19 and stroke were included. A total of 29 were under 50 years of age.
- The median age was 65 years and 43% were women. Among these cases, 125 were identified through a systematic literature search and 35 were new cases from London, Ontario, Iran and the USA.
1) A high proportion of patients admitted with COVID-19 experience a stroke before or during the hospital stay: 1.8% for all stroke types and 1.6% for ischemic strokes.
This is higher than historical data for other infectious diseases:
- 0.75% in SARS-COV-1
- 0.2% in influenza
This figure may be an underestimate given that many patients die without a confirmed diagnosis and that some patients did not go to the emergency department when they experienced mild symptoms during the early months of the pandemic.
2) Young patients are also at risk, 45% have absolutely no risk factors and in 50% of cases stroke is the first symptom of COVID-19.
This means that in 50% of young patients with COVID-19 and stroke, there were no typical COVID-19 symptoms before the onset of the stroke.
3) Mortality is high , between 35% and 45%, higher than the 15 to 30% reported for stroke patients without COVID-19 admitted to intensive care units.
4) We identified a phenotype or high risk group for death for all types of stroke considered together.
In this group:
- 100% had at least one significant comorbidity,
- 97% have severe COVID-19 symptoms
- Hospital mortality was 59%
- 10% were under 50 years of age
We found this by applying unsupervised learning, which allowed us to avoid any prior knowledge bias.
4) The proportion of ischemic stroke patients with large clots in the cerebral arteries was higher than previously reported for stroke patients without COVID-19. The proportion with a large vessel clot was 47% compared to 29% reported in previous studies of stroke patients without COVID-19.
5) The frequency of pulmonary embolism and deep vein thrombosis in this population is 14 times higher than previously reported for stroke patients without COVID-19 in Canada (11-13% vs 0.78%).
