Characteristics of patients with acute ischemic stroke and covid-19 who required intensive care unit admission versus ward-only: The mississippi academic center experience

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is a viral disease that has primarily been known to cause respiratory symptoms;however, there has also been an association of COVID-19 with neurological symptoms, including acute ischemic stroke (AIS). There is a lack of data on the characteristics of AIS patients with COVID-19 from the stroke belt. We aim to describe the characteristics of patients with COVID-19 and AIS and compare the characteristics of those who required intensive care unit (ICU) admission versus ward-only. Methods: Single center, retrospective cohort study of adult patients admitted in a tertiary academic center from March 1-December 31, 2020. The institutional COVID database was utilized for data collection. Demographic, clinical and laboratory data were collected. Primary outcome measure was mortality. Secondary outcomes included hospital length of stay (LOS) and discharge disposition. Results: Both COVID-19 and AIS were found in 2.4% (n=75) of patients out of 3,031 patients with COVID-19, during the study period. These patients were male (45, 60%), African American (43, 57%), 65±12 years old, with hypertension (69, 92%) and Diabetes Mellitus type 2 (50, 67%). We noted a 20% (n=15) overall in-patient mortality rate among patients with both COVID-19 and AIS. Among these patients, 23% (n=17) required ICU admission. Demographic, clinical and laboratory characteristics were comparable among ICU versus ward-only patients except for higher LDH (476.12±189.70 vs 276.17±88.35 U/L, p==0.0003);and lower relative lymphocytic count (3.57±3.56 vs 8.93±7.83 10 cells/μL, p=0.0160) among those admitted into the ICU. Mortality (13, 68% vs 6, 32%, p<0.001) was significantly higher among the ICU cohort while majority of the ward-only cohort were discharged home (21, 95%). Conclusion: We present the first description of characteristics and outcomes of patients with AIS and COVID-19 from Mississippi. Novel to this cohort is the comparison of those who were admitted into the ICU versus ward-only. Prospective studies analyzing larger datasets of COVID-19 and stroke in the stroke-belt are warranted to further study disparities of care and outcomes.