Abstract
BackgroundStroke in the course of coronavirus disease (COVID-19) has been shown to be associated with more severe respiratory symptoms and higher mortality, but little knowledge in this regard exists on older populations. We aimed to investigate the incidence, characteristics, and prognosis of acute stroke in geriatric patients hospitalized with COVID-19.MethodsA monocentric cross-sectional retrospective study of 265 older patients hospitalized with COVID-19 on acute geriatric wards. 11/265 presented a stroke episode during hospitalization. Mortality rates and two-group comparisons (stroke vs non-stroke patients) were calculated and significant variables added in logistic regression models to investigate stroke risk factors.ResultsCombined ischemic and hemorrhagic stroke incidence was 4.15%. 72.7% of events occurred during acute care. Strokes presented with altered state of consciousness and/or delirium in 81.8%, followed by a focal neurological deficit in 45.5%. Ischemic stroke was more frequently unilateral (88.8%) and localized in the middle cerebral artery territory (55.5%). Smoking and a history of previous stroke increased by more than seven (OR 7.44; 95% CI 1.75–31.64; p = 0.007) and five times (OR 5.19; 95% CI 1.50–17.92; p = 0.009), respectively, the risk of stroke. Each additional point in body mass index (BMI) reduced the risk of stroke by 14% (OR 0.86; 95% CI 0.74–0.98; p = 0.03). In-hospital mortality (32.1% vs. 27.3%; p > 0.999) and institutionalization at discharge (36.4% vs. 21.1%; p = 0.258) were similar between patients with and without stroke.ConclusionIncident stroke complicating COVID-19 in old patients was associated with active smoking, previous history of stroke, and low BMI. Acute stroke did not influence early mortality or institutionalization rate at discharge.
Highlights
Acute cerebrovascular complications have been reported through the course of bacterial and viral infections in both young and older patients [1, 2]
This study aimed to describe the incidence, and clinical and imaging characteristics of stroke, as well as their relationship with early mortality and destination at discharge, in a population of old and very old patients hospitalized with COVID-19
Characteristics of the study population and stroke risk factors The study population consisted of 265 patients with a mean age of 85.9 ± 6.5 years, 43% were male, and the inhospital mortality rate was 32.1%
Summary
Acute cerebrovascular complications have been reported through the course of bacterial and viral infections in both young and older patients [1, 2]. Acute stroke in the course of COVID-19 was associated with higher severity of respiratory symptoms and mortality in the acute phase. The majority of studies available describe younger populations and little knowledge exists on acute stroke in old and very old patients with COVID-19. Older patients with COVID-19 present worse disease outcomes than younger patients, with increased mortality [10], having led to characterize them as a group at risk for more severe disease course and complications. Stroke in the course of coronavirus disease (COVID-19) has been shown to be associated with more severe respiratory symptoms and higher mortality, but little knowledge in this regard exists on older populations. We aimed to investigate the incidence, characteristics, and prognosis of acute stroke in geriatric patients hospitalized with COVID-19
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