Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza

• Published in: Archives of neurology (Chicago) Vol. 77; no. 11; p. 1366
• Main Authors: Merkler, Alexander E, Parikh, Neal S, Mir, Saad, Gupta, Ajay, Kamel, Hooman, Lin, Eaton, Lantos, Joshua, Schenck, Edward J, Goyal, Parag, Bruce, Samuel S, Kahan, Joshua, Lansdale, Kelsey N, LeMoss, Natalie M, Murthy, Santosh B, Stieg, Philip E, Fink, Matthew E, Iadecola, Costantino, Segal, Alan Z, Cusick, Marika, Campion, Jr, Thomas R, Diaz, Ivan, Zhang, Cenai, Navi, Babak B
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01.11.2020
• Subjects: Adults; Coronaviridae; Coronaviruses; COVID-19; Emergency medical care; Emergency medical services; Health risks; Hospitalization; Hospitals; Infections; Influenza; Influenza A; Ischemia; Men; Nasopharynx; Patients; Polymerase chain reaction; Public health; Regression analysis; Respiratory diseases; Risk analysis; Risk factors; Sensitivity analysis; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Stroke; Viral diseases; United States > US; New York City New York
• ISSN: 2168-6149; 2168-6157
• DOI: 10.1001/jamaneurol.2020.2730

It is uncertain whether coronavirus disease 2019 (COVID-19) is associated with a higher risk of ischemic stroke than would be expected from a viral respiratory infection. To compare the rate of ischemic stroke between patients with COVID-19 and patients with influenza, a respiratory viral illness previously associated with stroke. This retrospective cohort study was conducted at 2 academic hospitals in New York City, New York, and included adult patients with emergency department visits or hospitalizations with COVID-19 from March 4, 2020, through May 2, 2020. The comparison cohort included adults with emergency department visits or hospitalizations with influenza A/B from January 1, 2016, through May 31, 2018 (spanning moderate and severe influenza seasons). COVID-19 infection confirmed by evidence of severe acute respiratory syndrome coronavirus 2 in the nasopharynx by polymerase chain reaction and laboratory-confirmed influenza A/B. A panel of neurologists adjudicated the primary outcome of acute ischemic stroke and its clinical characteristics, mechanisms, and outcomes. We used logistic regression to compare the proportion of patients with COVID-19 with ischemic stroke vs the proportion among patients with influenza. Among 1916 patients with emergency department visits or hospitalizations with COVID-19, 31 (1.6%; 95% CI, 1.1%-2.3%) had an acute ischemic stroke. The median age of patients with stroke was 69 years (interquartile range, 66-78 years); 18 (58%) were men. Stroke was the reason for hospital presentation in 8 cases (26%). In comparison, 3 of 1486 patients with influenza (0.2%; 95% CI, 0.0%-0.6%) had an acute ischemic stroke. After adjustment for age, sex, and race, the likelihood of stroke was higher with COVID-19 infection than with influenza infection (odds ratio, 7.6; 95% CI, 2.3-25.2). The association persisted across sensitivity analyses adjusting for vascular risk factors, viral symptomatology, and intensive care unit admission. In this retrospective cohort study from 2 New York City academic hospitals, approximately 1.6% of adults with COVID-19 who visited the emergency department or were hospitalized experienced ischemic stroke, a higher rate of stroke compared with a cohort of patients with influenza. Additional studies are needed to confirm these findings and to investigate possible thrombotic mechanisms associated with COVID-19.