Stroke is 4 to 7 times likelier with COVID-19 than with influenza

  • Merkler AE & al.
  • JAMA Neurol
  • 2 Jul 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Stroke is much more common among patients with COVID-19 than among patients with influenza.
  • Mortality is also higher for patients with COVID-19 who experience stroke vs those who do not.

Why this matters

  • Providers should be vigilant for stroke in patients with COVID-19.
  • COVID-19 is often incorrectly compared with influenza in its severity.

Key results

  • Acute ischemic stroke rates (95% CIs) with:
    • COVID-19: 1.6% (1.1%-2.3%).
    • Influenza: 0.2% (0.0%-0.6%).
  • Mortality among patients with COVID-19 with vs without stroke: 32% vs 14% (P=.003).
  • aOR (95% CI) for stroke, COVID-19 vs influenza: 
    • Adjusted for age, sex, and race: 7.6 (2.3-25.2).
    • Additionally adjusted for vascular risk factors and ICU admissions: 4.6 (1.4-15.7).

Study design

  • A 2-hospital retrospective cohort study in New York City. 
  • Authors assessed outcomes among adults with emergency department (ED) visits or hospitalizations related to laboratory-confirmed coronavirus infection between March 4, 2020 and May 2, 2020 (n=1916).
  • Comparators: adults with ED visits or hospitalizations related to laboratory-confirmed influenza, January 2016-May 2018 (n=1486).
  • Outcome: acute ischemic stroke.
  • Funding: NIH; New York-Presbyterian Hospital; Weill Cornell Medical College.

Limitations

  • Some cases of stroke may have been missed because of death or inability to undergo CT scan.
  • Comparative illness severity of patients with COVID-19 vs influenza is unclear.