Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States
Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes. We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital d...
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| creator | de Havenon, Adam Ney, John P. Callaghan, Brian Delic, Alen Hohmann, Samuel Shippey, Ernie Esper, Gregory J. Stulberg, Eric Tirschwell, David Frontera, Jennifer Yaghi, Shadi Anadani, Mohammad Majersik, Jennifer J. |
| description | Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes.
We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW).
In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2020.105535 |
| format | Article |
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We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW).
In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p<0.05). Black and Hispanic patients accounted for 21.7% and 7.4% of IS controls, respectively, but 33.7% and 18.5% of IS-COVID (p<0.001). IS-COVID, versus IS controls, were less likely to receive alteplase (1.8% vs 5.6%, p<0.001), mechanical thrombectomy (4.4% vs. 6.7%, p<0.001), to have favorable discharge (33.9% vs. 66.4%, p<0.001), but more likely to die (30.4% vs. 6.5%, p<0.001). In the matched cohort of patients with IS-COVID and IS-PNA, IS-COVID had a higher risk of death (IPW-weighted OR 1.56, 95% CI 1.33-1.82) and lower odds of favorable discharge (IPW-weighted OR 0.63, 95% CI 0.54-0.73).
Ischemic stroke patients with COVID-19 are more likely to be male, younger, and Black or Hispanic, with significant increases in morbidity and mortality compared to both ischemic stroke controls from 2019 and to patients with ischemic stroke and pneumonia.]]></description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2020.105535</identifier><identifier>PMID: 33310595</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Age Factors ; Aged ; Comorbidity ; COVID-19 ; COVID-19 - diagnosis ; COVID-19 - epidemiology ; COVID-19 - mortality ; COVID-19 - therapy ; Databases, Factual ; Epidemiology ; Female ; Hospital Mortality ; Humans ; Ischemic stroke ; Ischemic Stroke - diagnosis ; Ischemic Stroke - epidemiology ; Ischemic Stroke - mortality ; Ischemic Stroke - therapy ; Male ; Middle Aged ; Neurology/cerebrovascular disease ; Outcome ; Patient Discharge ; Race Factors ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sex Factors ; Time Factors ; Treatment Outcome ; United States ; Young Adult</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2021-02, Vol.30 (2), p.105535-105535, Article 105535</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020 Elsevier Inc. All rights reserved. 2020 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c519t-ab5921cb23ac4c7f2b08c83d50f4735dc6b53f30250c63b32f90b620f9dc29c13</citedby><cites>FETCH-LOGICAL-c519t-ab5921cb23ac4c7f2b08c83d50f4735dc6b53f30250c63b32f90b620f9dc29c13</cites><orcidid>0000-0003-3191-262X ; 0000-0001-9106-1594 ; 0000-0002-0719-2522 ; 0000-0001-8178-8597 ; 0000-0002-7813-2949 ; 0000-0002-8885-6748</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1052305720309538$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33310595$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Havenon, Adam</creatorcontrib><creatorcontrib>Ney, John P.</creatorcontrib><creatorcontrib>Callaghan, Brian</creatorcontrib><creatorcontrib>Delic, Alen</creatorcontrib><creatorcontrib>Hohmann, Samuel</creatorcontrib><creatorcontrib>Shippey, Ernie</creatorcontrib><creatorcontrib>Esper, Gregory J.</creatorcontrib><creatorcontrib>Stulberg, Eric</creatorcontrib><creatorcontrib>Tirschwell, David</creatorcontrib><creatorcontrib>Frontera, Jennifer</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Anadani, Mohammad</creatorcontrib><creatorcontrib>Majersik, Jennifer J.</creatorcontrib><title>Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description><![CDATA[Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes.
We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW).
In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p<0.05). Black and Hispanic patients accounted for 21.7% and 7.4% of IS controls, respectively, but 33.7% and 18.5% of IS-COVID (p<0.001). IS-COVID, versus IS controls, were less likely to receive alteplase (1.8% vs 5.6%, p<0.001), mechanical thrombectomy (4.4% vs. 6.7%, p<0.001), to have favorable discharge (33.9% vs. 66.4%, p<0.001), but more likely to die (30.4% vs. 6.5%, p<0.001). In the matched cohort of patients with IS-COVID and IS-PNA, IS-COVID had a higher risk of death (IPW-weighted OR 1.56, 95% CI 1.33-1.82) and lower odds of favorable discharge (IPW-weighted OR 0.63, 95% CI 0.54-0.73).
Ischemic stroke patients with COVID-19 are more likely to be male, younger, and Black or Hispanic, with significant increases in morbidity and mortality compared to both ischemic stroke controls from 2019 and to patients with ischemic stroke and pneumonia.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Comorbidity</subject><subject>COVID-19</subject><subject>COVID-19 - diagnosis</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - mortality</subject><subject>COVID-19 - therapy</subject><subject>Databases, Factual</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Ischemic stroke</subject><subject>Ischemic Stroke - diagnosis</subject><subject>Ischemic Stroke - epidemiology</subject><subject>Ischemic Stroke - mortality</subject><subject>Ischemic Stroke - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurology/cerebrovascular disease</subject><subject>Outcome</subject><subject>Patient Discharge</subject><subject>Race Factors</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Young Adult</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkVtrGzEQhUVIadK0fyHosQTW0WW1l5dC66SJweBA674K7exsLMe7ciXZkH8f2U5CCn3J0wycwznDfIRccDbijBeXy9EyRO8eENBj493WhNaGkWBiZ1BKqiNyypUUWaU4P047UyKTTJUn5FMIS8Y4V5X6SE6klEmr1SmZTfq1gUhdR8ezP5OrjNfUDXS2ieB6DNQOdBJggb0F-mtfTu9MtDjEvRYXSOeDjdgm1UQMn8mHzqwCfnmeZ2T-8_r3-Dabzm4m4-_TDBSvY2YaVQsOjZAGcig70bAKKtkq1uWlVC0UjZKdZEIxKGQjRVezphCsq1sQNXB5Rr4dctebpscW0kHerPTa2974R-2M1f8qg13oe7fVZSVFLooU8PU5wLu_GwxR9zYArlZmQLcJWuQlY6KsizxZfxys4F0IHrvXGs70joxe6v-R0Tsy-kAmhZy_Pfg14gVFMkwPBkxv21r0OkD6M2BrPULUrbPv6XsCAJutmg</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>de Havenon, Adam</creator><creator>Ney, John P.</creator><creator>Callaghan, Brian</creator><creator>Delic, Alen</creator><creator>Hohmann, Samuel</creator><creator>Shippey, Ernie</creator><creator>Esper, Gregory J.</creator><creator>Stulberg, Eric</creator><creator>Tirschwell, David</creator><creator>Frontera, Jennifer</creator><creator>Yaghi, Shadi</creator><creator>Anadani, Mohammad</creator><creator>Majersik, Jennifer J.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3191-262X</orcidid><orcidid>https://orcid.org/0000-0001-9106-1594</orcidid><orcidid>https://orcid.org/0000-0002-0719-2522</orcidid><orcidid>https://orcid.org/0000-0001-8178-8597</orcidid><orcidid>https://orcid.org/0000-0002-7813-2949</orcidid><orcidid>https://orcid.org/0000-0002-8885-6748</orcidid></search><sort><creationdate>20210201</creationdate><title>Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States</title><author>de Havenon, Adam ; Ney, John P. ; Callaghan, Brian ; Delic, Alen ; Hohmann, Samuel ; Shippey, Ernie ; Esper, Gregory J. ; Stulberg, Eric ; Tirschwell, David ; Frontera, Jennifer ; Yaghi, Shadi ; Anadani, Mohammad ; Majersik, Jennifer J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c519t-ab5921cb23ac4c7f2b08c83d50f4735dc6b53f30250c63b32f90b620f9dc29c13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Comorbidity</topic><topic>COVID-19</topic><topic>COVID-19 - diagnosis</topic><topic>COVID-19 - epidemiology</topic><topic>COVID-19 - mortality</topic><topic>COVID-19 - therapy</topic><topic>Databases, Factual</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Ischemic stroke</topic><topic>Ischemic Stroke - diagnosis</topic><topic>Ischemic Stroke - epidemiology</topic><topic>Ischemic Stroke - mortality</topic><topic>Ischemic Stroke - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurology/cerebrovascular disease</topic><topic>Outcome</topic><topic>Patient Discharge</topic><topic>Race Factors</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Havenon, Adam</creatorcontrib><creatorcontrib>Ney, John P.</creatorcontrib><creatorcontrib>Callaghan, Brian</creatorcontrib><creatorcontrib>Delic, Alen</creatorcontrib><creatorcontrib>Hohmann, Samuel</creatorcontrib><creatorcontrib>Shippey, Ernie</creatorcontrib><creatorcontrib>Esper, Gregory J.</creatorcontrib><creatorcontrib>Stulberg, Eric</creatorcontrib><creatorcontrib>Tirschwell, David</creatorcontrib><creatorcontrib>Frontera, Jennifer</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Anadani, Mohammad</creatorcontrib><creatorcontrib>Majersik, Jennifer J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Havenon, Adam</au><au>Ney, John P.</au><au>Callaghan, Brian</au><au>Delic, Alen</au><au>Hohmann, Samuel</au><au>Shippey, Ernie</au><au>Esper, Gregory J.</au><au>Stulberg, Eric</au><au>Tirschwell, David</au><au>Frontera, Jennifer</au><au>Yaghi, Shadi</au><au>Anadani, Mohammad</au><au>Majersik, Jennifer J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>30</volume><issue>2</issue><spage>105535</spage><epage>105535</epage><pages>105535-105535</pages><artnum>105535</artnum><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract><![CDATA[Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes.
We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW).
In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p<0.05). Black and Hispanic patients accounted for 21.7% and 7.4% of IS controls, respectively, but 33.7% and 18.5% of IS-COVID (p<0.001). IS-COVID, versus IS controls, were less likely to receive alteplase (1.8% vs 5.6%, p<0.001), mechanical thrombectomy (4.4% vs. 6.7%, p<0.001), to have favorable discharge (33.9% vs. 66.4%, p<0.001), but more likely to die (30.4% vs. 6.5%, p<0.001). In the matched cohort of patients with IS-COVID and IS-PNA, IS-COVID had a higher risk of death (IPW-weighted OR 1.56, 95% CI 1.33-1.82) and lower odds of favorable discharge (IPW-weighted OR 0.63, 95% CI 0.54-0.73).
Ischemic stroke patients with COVID-19 are more likely to be male, younger, and Black or Hispanic, with significant increases in morbidity and mortality compared to both ischemic stroke controls from 2019 and to patients with ischemic stroke and pneumonia.]]></abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33310595</pmid><doi>10.1016/j.jstrokecerebrovasdis.2020.105535</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-3191-262X</orcidid><orcidid>https://orcid.org/0000-0001-9106-1594</orcidid><orcidid>https://orcid.org/0000-0002-0719-2522</orcidid><orcidid>https://orcid.org/0000-0001-8178-8597</orcidid><orcidid>https://orcid.org/0000-0002-7813-2949</orcidid><orcidid>https://orcid.org/0000-0002-8885-6748</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Adult Age Factors Aged Comorbidity COVID-19 COVID-19 - diagnosis COVID-19 - epidemiology COVID-19 - mortality COVID-19 - therapy Databases, Factual Epidemiology Female Hospital Mortality Humans Ischemic stroke Ischemic Stroke - diagnosis Ischemic Stroke - epidemiology Ischemic Stroke - mortality Ischemic Stroke - therapy Male Middle Aged Neurology/cerebrovascular disease Outcome Patient Discharge Race Factors Retrospective Studies Risk Assessment Risk Factors Sex Factors Time Factors Treatment Outcome United States Young Adult |
| title | Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States |
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