Abstract TMP12: COVID-19 Increases The Risk Of In-Hospital Acute Stroke Mortality: A Cohort Study

Abstract

Introduction: Coronavirus disease (COVID-19) infection has an increased risk for neurological complications. Stroke has been associated with COVID-19 in 1-3% of hospitalized patients. Methods: This is a retrospective cohort study of stroke patients admitted in a health center in Brazil. We aimed to investigate whether the exposure to COVID-19 was associated with an increase in acute stroke mortality. The primary outcome was in-hospital mortality. Results: The cohort included 1191 stroke patients (54% male). All strokes were included: Ischemic stroke (81.2%), hemorrhagic stroke (14.9), cerebral venous thrombosis (2.1%) and subarachnoid hemorrhage (1.3%). Stroke associated with COVID-19 represented 5.4% of all patients. Mean age was 64.4 years (SD 0.5) and did not differ between groups. Sex distributions were equal in patients with or without covid-19. The prevalence of stroke type and the TOAST classification were similar in both groups. Mean NIHSS score was 8.7 (SD 6.3) being significantly higher in COVID-19 patients (p=0.036). COVID-19 patients disclosed a higher frequency of previous ischemic heart disease (OR: 3.5 - CI: 1.86-6.46). The frequency of arterial hypertension, diabetes mellitus, tobacco and alcohol use, and atrial fibrillation were similar for both groups. COVID-19 patients disclosed higher odds for in-hospital infection (OR: 4.5; CI: 2.67-7.48). Mortality rate was higher for COVID-19 patients (44.6% against 20.1% in non-Covid-19 group) in all subtypes of stroke. The mortality risk was twofold for COVID-19 stroke patients (CI: 1.62-2.92). Multivariate logistic regression considering mortality as the primary outcome and adjusted for multiple confounders disclosed an adjusted OR of 2.3 for COVID-19 infection (CI: 1.1-4.9) (Figure). Conclusion: In this cohort study, COVID-19 infection was an independent risk factor for mortality in stroke patients, regardless of comorbidities, age, sex and NIHSS.