ABSTRACT
Background: Acute ischemic stroke (AIS) is a frequent complication of coronavirus disease (COVID-19), but the prognosis of these patients is poorly understood. Aim: To explore the impact of COVID-19 on neurological outcome in AIS patients. Methods: A comparative retrospective cohort study was conducted in 32 consecutive AIS patients with and 51 without COVID-19 between the 1st of March 2020 and 1st of May 2021. The evaluation was based on a detailed chart review for demographic data, medical history, stroke severity, cranial and vessel imaging results, laboratory parameters, COVID-19 severity, hospitalization time, in-hospital mortality, and functional deficits at discharge (modified Rankin Scale, mRS). Results: COVID-19 AIS patients had worse initial neurological deficit (NIHSS 9 (3-13) vs. 4 (2-10);p=0.06), showed tendency to higher rate of large vessel occlusion (LVO;13/32 vs. 14/51;p=0.21), had prolonged hospitalization (19.4 ± 17.7 vs. 9.7 ± 7 days;p=0.003), had lower chance of functional independence (mRS≤2) (12/32 vs. 32/51;p=0.02) and showed higher in-hospital mortality (10/32 vs. 6/51;p=0.02). In COVID-19 AIS patients, LVO was more common with COVID-19 pneumonia than without (55.6% vs. 23.1%;p=0.139). Conclusion: COVID-19-related AIS carries a worse prognosis. COVID- 19 with pneumonia seems to be associated with a higher rate of LVO.
ABSTRACT
Background and aims: Our previous study demonstrated a significant disruption in ischemic stroke care during the COVID-19 outbreak in Hungary, with a significant decline in mechanical thrombectomy (MT). We aimed to assess the differences between thrombectomy centres. Methods: In our nationwide retrospective study, we assessed the number of MTs between 2/01/2017-31/12/2020 in Hungary. Thrombectomy centres were categorized as high- or low-volume (weekly median EVT ≥5 or <5) centres, which data then were pooled into high- and lowvolume groups. COVID-19's impact on pooled MT volumes was analyzed during the first two epidemic waves, comparing weekly medians of raw and standardized (z-scores) MT numbers to the identical period of the previous year. Results: Although during the first epidemic wave, the raw MT numbers did not change considerably either in the high- or low-volume groups (10.00 vs 9.00, p=0.875;11.96 vs 12.93, p=1, respectively), the analysis of z-scores showed a significant decline in the low-volume cohort, but not in the high-volume group (-0.19 vs -0.93, p=0.015;0.60 vs -0.47, p=0.057). During the second epidemic wave, raw and standardized MT numbers decreased significantly in the low-volume but not in the high-volume group (raw numbers: 14.93 vs 12.96, p=0.035;8.00 vs 9.00, p=0.836;respectively. z-scores: 0.39 vs -1.69, p<0.001;-0.40 vs -0.74, p=0.243, respectively). Conclusions: Our study demonstrated a remarkable decline in MT numbers in the low-volume but not in the high-volume group of thrombectomy centres. One of the reasons may be the different institutional settings and involvement in the action against COVID-19.
ABSTRACT
IntroductionAlthough most of the stroke centers reported a remarkable decline in stroke care during the coronavirus disease 2019 (COVID-19) pandemic, data from Central Europe are limited.ObjectivesWe aimed to assess the impact of the ongoing pandemic on the Hungarian ischemic stroke (IS) care system.MethodsAt a national level, we retrospectively accessed the number of IS admissions and reperfusion therapies, i.e., intravenous thrombolysis (IVT) and endovascular therapy (EVT), from 2 January 2017 to 31 December 2020 in Hungary. We used different statistics (means, medians, trends, relative rates, linear relationships) to analyze the impact of the COVID-19 outbreak on the number of IS admissions and reperfusion therapies.ResultsAlthough the non-standardized number of IS admissions, IVTs and EVTs decreased only in some measure during the COVID-19 epidemic, the trend analysis demonstrated a significant disruption in the trends. The reduction’s dynamic and extent have differed for each variable, and the number of IS admissions decreased to a disproportionally larger extent than the number of IVTs and EVTs. In contrast to IVT, the number of IS admissions and EVTs showed a significant negative linear correlation with the number of new or cumulative COVID-19 cases in Hungary.ConclusionsCollateral damages of the COVID-19 outbreak on the Hungarian IS care system were demonstrated. The disproportionally greater decline of IS admission numbers could partially be explained by the effect of health emergency operative measures. Further studies are needed to evaluate the causes of our observations.ReferencesBersano A, Kraemer M, Touzé E, Weber R, Alamowitch S, Sibon I, et al. Stroke care during the COVID-19 pandemic: experience from three large European countries. Eur J Neurol 2020;27(9):1794–800. https://doi.org/10.1111/ene.14375Böjti PP, Stang R, Gunda B, Sipos I, Bereczki D. A járulékos egészségügyi veszteségek retrospektív, egycentrumos felmérése. [Effects of COVID-19 pandemic on acute ischemic stroke care. A single-centre retrospective analysis of medical collateral damage]. Orv Hetil 2020;161(34):1395–9. https://doi.org/10.1556/650.2020.31936. Hungarian.Slowik A, Nowak R, Popiela T. Significant fall in stroke admissions in the Malopolska Voivodeship of Poland during the COVID-19 pandemic. Neurol Neurochir Pol 2020;54(5):471–2. https://doi.org/10.5603/PJNNS.a2020.0056DisclosureNothing to disclose