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JAMA Neurol
. 2020 Jul 2.
doi: 10.1001/jamaneurol.2020.2730. Online ahead of print.
Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza
Alexander E Merkler 1 , Neal S Parikh 1 , Saad Mir 1 , Ajay Gupta 1 2 , Hooman Kamel 1 3 , Eaton Lin 2 , Joshua Lantos 2 , Edward J Schenck 4 , Parag Goyal 5 , Samuel S Bruce 1 , Joshua Kahan 1 , Kelsey N Lansdale 1 , Natalie M LeMoss 1 , Santosh B Murthy 1 , Philip E Stieg 6 , Matthew E Fink 1 , Costantino Iadecola 1 , Alan Z Segal 1 , Marika Cusick 7 , Thomas R Campion Jr 7 , Ivan Diaz 7 , Cenai Zhang 1 , Babak B Navi 1
AffiliationsExpand
- PMID: 32614385
- DOI: 10.1001/jamaneurol.2020.2730
Abstract
Importance: 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.
Objective: To compare the rate of ischemic stroke between patients with COVID-19 and patients with influenza, a respiratory viral illness previously associated with stroke.
Design, setting, and participants: 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).
Exposures: 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.
Main outcomes and measures: 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.
Results: 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.
Conclusions and relevance: 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.