Response by Kummer et al to Letter Regarding Article, "History of Stroke Is Independently Associated With In-Hospital Death in Patients With COVID-19".

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HomeStrokeVol. 52, No. 1Response by Kummer et al to Letter Regarding Article, “History of Stroke Is Independently Associated With In-Hospital Death in Patients With COVID-19” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse by Kummer et al to Letter Regarding Article, “History of Stroke Is Independently Associated With In-Hospital Death in Patients With COVID-19” Benjamin R. Kummer, MD, Eyal Klang, MD and Nathalie Jetté, MD, MSc Benjamin R. KummerBenjamin R. Kummer https://orcid.org/0000-0002-1413-8014 Department of Neurology (B.R.K., N.J.), Icahn School of Medicine at Mount Sinai, New York, NY. Clinical Informatics, Mount Sinai Health System, New York, NY (B.R.K.). Search for more papers by this author , Eyal KlangEyal Klang Population Health Science and Policy (E.K., N.J.), Icahn School of Medicine at Mount Sinai, New York, NY. Department of Radiology, Sheba Medical Center, Ramat Gan, Israel (E.K.). Search for more papers by this author and Nathalie JettéNathalie Jetté Department of Neurology (B.R.K., N.J.), Icahn School of Medicine at Mount Sinai, New York, NY. Population Health Science and Policy (E.K., N.J.), Icahn School of Medicine at Mount Sinai, New York, NY. Division of Health Outcomes and Knowledge Translation Research, Department of Neurology (N.J.), Icahn School of Medicine at Mount Sinai, New York, NY. Search for more papers by this author Originally published28 Dec 2020https://doi.org/10.1161/STROKEAHA.120.032886Stroke. 2021;52:e31In Response:We would like to thank Cao et al1 for their interest in our study. We agree that it is important to consider the severity of respiratory disease when characterizing the relationship between the history of stroke and mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). To this point, we conducted a sensitivity analysis wherein our original multivariable logistic regression model was adjusted for the presence of oxygen saturation below 90% on admission. In this newly adjusted analysis, a history of stroke remained significantly associated with in-hospital mortality (adjusted odds ratio, 1.51 [95% CI, 1.17–1.96]).We nonetheless agree with Cao et al’s1 astute observations that these findings require further confirmation through analyses that incorporate larger patient cohorts and adjust for several additional factors that are associated with mortality in COVID-19. These include laboratory markers such as ferritin, serum interleukins, blood cell counts and D-dimer levels,2,3 in addition to clinical factors such as intubation status and presence of comorbid acute stroke.Additionally, it is important to take into consideration the timeframe of our study when interpreting its results. The period between March and May of 2020 spanned the peak of the first COVID-19 pandemic wave in New York City,4 which may explain the high rates of COVID-19 infection and in-hospital mortality that we found in our analysis, and may have affected the generalizability of our results. These facts lend further support to the idea that our findings should be further investigated in additional studies that include periods with both high and low community transmission of COVID-19.Sources of FundingNone.DisclosuresDr Jetté receives grant funding paid to her institution for grants unrelated to this work from National Institute of Neurological Disorders and Stroke (NINDS; National Institutes of Health [NIH] U24NS107201, NIH IU54NS100064) and Patient-Centered Outcomes Research Institute. She is Bludhorn Professor of International Medicine at the Icahn School of Medicine at Mount Sinai. She receives an honorarium for her work as an Associate Editor of Epilepsia. The other authors report no conflicts.FootnotesThis article was sent to Marc Fisher, Senior Consulting Editor, for editorial decision and final disposition.For Sources of Funding and Disclosures, see page e31.