Stroke-Related Inpatient Morality Increased During COVID-19 Pandemic

Relative to pre-pandemic era, the odds of mortality in stroke-related admissions increased during the pandemic, with an even greater risk for those less than 70 years of age.

Data from a large meta-analysis of more than 30 studies revealed a significantly increased risk of mortality in patients hospitalized for stroke during the COVID-19 pandemic compared to the pre-COVID era. These findings were presented at the 2022 International Stroke Conference (ISC), February 9-11, in New Orleans, Louisiana, by lead author Rupak Desai, MBBS, research fellow, Atlanta VA Medical Center.1

A total of 31 studies that reported on stroke and stroke-related inpatient morality (SRIM) were extracted from SCOPUS and EMBASE databases and used for analysis. Desai and colleagues employed random-effects model for odds ratio (OR), I2 statistics for heterogeneity assessment, and leave-one-out method fully assess the risk of SRIM during the COVID pandemic vs pre-pandemic.

The analysis included 455,073 stroke hospitalizations, 365,253 of which were pre-pandemic and 89,820 of which occurred during the pandemic. When comparing the time frames, patients hospitalized for stroke, elderly or nonelderly, during the pandemic had a nearly 40% higher risk of morality compared to those pre-pandemic (odds ratio [OR], 1.42; 95% CI, 1.06-1.92; P = .018; I2 = 98.59).

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Patients who were younger than 70 years old showed an even slightly higher risk of mortality (OR, 1.48; P = .020) compared to those who were 70 years and older (OR, 1.27; P <.001). When comparing subgroups based on continents, there was a significantly higher mortality in Europe (OR, 1.31; P <.001) during pandemic vs pre-pandemic, and a nonsignificantly higher association in Asia (OR, 1.13; P = .57), the United States (OR, 1.59; P = .23), and Africa (OR, 1.20; P = .46).

A significantly higher OR for SRIM (1.31) was found in a subgroup analysis that only included studies that had between 100 and 1000 participants, whereas no significant difference was observed for studies that had either less than 100 participants or more than 1000 participants.

Since the beginning of the pandemic, there has been more evidence alluding to a neuropathological effect from the virus. A recently published study that sampled over 37,000 patients hospitalized with COVID-19 found that roughly 1 in every 100 patients will develop central nervous system complications, with those that underwent neuroimaging found to have a 10% incidence of complication (7.9% in the US vs 22.8% in the EU).2

Data presented at the American Stroke Association’s ISC 2021, also suggested that patients with stroke and COVID-19 are younger than typical stroke patients, with greater stroke severity and worse outcomes after mechanical thrombectomy. These patients also were more likely to have multiple large vessel occlusions (17.9% vs 8.1%; P <.03) and had greater median scores on National Institutes of Health Stroke Scale (8 vs 5; P <.002) than patients with ischemic stroke alone. Fatalities occurred in 19.8% of ischemic strokes among patients with COVID-19 compared to 9.6% of patients in the control group (P <.00003).3

For more coverage of ISC 2022, click here.