Characteristics and Outcomes of Stroke Patients with Concurrent SARS-CoV-2 Infection from March 1, 2020 to February 28, 2021: An Analysis from the N3C Database

ABSTRACT

Objective: To test the association of SARS-CoV-2 infection with increased stroke severity in individuals with ischemic and hemorrhagic stroke during the first year of the COVID-19 pandemic in the US. Background: Studies have shown that patients with ischemic stroke (IS) and concurrent COVID19 have increased stroke severity. These analyses were limited by use of prepandemic era controls or by use of a sample from the early pandemic when stroke care delivery was affected by lockdown. Data on the severity of hemorrhagic stroke (HS) in patients with COVID-19 are sparse. Design/Methods: Using the National Institute of Health (NIH) National COVID Cohort Collaborative (N3C) database, we identified patients diagnosed with stroke between Mar 1, 2020 - Feb 28, 2021. Hospitalized stroke patients with concurrent COVID-19 (stroke within 3 months after or one week prior to positive SARS-CoV-2 PCR or AG lab test) were matched to all other hospitalized stroke patients in a 13 ratio. Nearest neighbor matching with a caliper of 0.25 was used for most clinical and demographic factors;exact matching for race/ethnicity and site. Within our matched sample, we used Poisson regression to calculate stroke severity incident rate ratio (IRR). Results: Our query identified 10394 patients hospitalized with IS with NIHSS scores upon admission (802 with concurrent COVID-19 and 9592 without) and 2138 patients hospitalized with HS with admission NIHSS scores (181 with concurrent COVID-19 and 1957 without). Average NIHSS was greater in concurrent groups with both IS and HS (11.1 vs 7.68, p<0.001 and 15.7 vs 11.7, p<0.001 respectively). Propensity matched analysis demonstrated that stroke patients with concurrent COVID-19 had increased NIHSS (IS IRR=1.4, 95% CI1.3-1.5, p<0.001;HS IRR=1.3, 95% CI1.2-1.5, p<0.001). Conclusions: This analysis suggests that the association between increased stroke severity and COVID-19 remained as stroke care utilization normalized. Further work will center on the interaction between COVID-19 illness severity and stroke severity.