ABSTRACT
Objective: To determine the risk factors of stroke among COVID 19 patients and analyze if there is an association between these factors and the incidence of stroke, and between mortality and stroke, in this cohort. Background: While most large studies about the possible association of COVID 19 and stroke were done in rich countries, only few small studies have been done in low to mid income countries like the Philippines. Design/Methods: This is an observational study done in 37 referral hospitals for COVID-19 all over the country. RT-PCR confirmed adult COVID-19 patients more than 18 years of age were included in the study. For those who consented, a pre-made detailed ion form containing the variables of interest is filled up by the field neurologist by clinical observation, chart review and interview of the relatives or the patient. Results: The incidence of stroke among COVID-19 patients was 3.4% (n=367). More died among patients with stroke than those without (42.2% vs 14.7%, p<0.01). In addition, more patients were admitted in the ICU (43.3% vs 15.0%, p<0.01) regardless of causes in the same cohort. Smoking (95% CI: 0.27 to 0.53, p<0.0001), hypertension (95% CI:0.43 to 0.68, p<0.0001), presence of heart failure (95% CI: 0.07 to 0.62, p=0.01), presence of any past neurologic co-morbidities (95% CI:0.34 to 0.10, p=0.004) and past history of stroke (95% CI:0.60 to 1.09, p<0.0001) had positive while being a health care worker (95% CI: -1.12 to -0.35, p<0.0004) had negative significant associations with stroke. Conclusions: COVID 19 stroke patients in LMIC have higher mortality and ICU admission rates than patients with COVID 19 alone or COVID 19 stroke patients from developed countries.
ABSTRACT
Objective: We aimed to investigate the associations between new-onset neurological symptoms (NNS) and mortality, respiratory failure, intensive care unit (ICU) admission, duration of ventilator dependence, length of ICU and hospital stay among COVID-19 patients. Background: Current reports of neurological symptoms/signs, complications, and outcomes of COVID-19 infection are limited due to the small number of included patients and relatively short duration of data collection which could hinder more precise estimates and detection of rarer manifestations. Design/Methods: We conducted a nationwide, comparative, retrospective, cohort study among adult, hospitalized COVID-19 patients involving 37 hospital sites from various regions in the Philippines. Results: We included a total of 10,881 patients with confirmed COVID-19 infection (2,008 had NNS;8,873 did not have NNS). The most common NNS were headache (n = 607, 5.58%), anosmia/hyposmia (n = 544, 5.0%), and altered sensorium (n = 479, 4.4%). The adjusted hazard ratios (aHRs) for mortality among the mild and severe cases were significantly higher by 1.660 (95% CI 1.132-2.435) and by 1.352 (95% CI 1.042-1.752), respectively, in the NNS group compared to those in the non-NNS group. The aHRs for respiratory failure in the NNS group were significantly increased by 1.914 (95% CI 1.346-2.722), by 1.614 (95% CI 1.260-2.068), and by 1.234 (95% CI 1.089-1.398) among the mild, severe, and critical cases, respectively. The aHRs for ICU admission in the NNS group were still significantly higher by 1.973 (95% CI 1.457-2.673) and by 1.831 (95% CI 1.506-2.226) among the mild and severe cases, respectively. Patients who had NNS were not significantly associated with a longer duration of ventilator dependence (adjusted odds ratio (aOR) 0.954, 95% CI 0.772-1.179), longer ICU stay (aOR 0.983, 95% CI 0.772-1.252) and longer hospital admission (aOR 1.045, 95% CI 0.947-1.153). Conclusions: The presence of NNS significantly increases the risk of mortality, respiratory failure and ICU admission among COVID-19 patients.