Comparison of Clinical Characteristics of COVID-19-Related and Unrelated Acute Stroke Patients During the COVID-19 Pandemic in Turkey

Objectives: Data on the co-occurrence of stroke and coronavirus disease 2019 (COVID-19) infection are limited and need to be improved. In our study, we aimed to evaluate the clinical and laboratory characteristics of COVID-19-related patients admitted to our center with acute stroke and compare them with acute stroke patients without COVID-19 infection during the same period.
Methods: One hundred and eighty-four patients admitted with acute stroke from March 11, 2020, to May 11, 2020, were included in the study. Demographic and clinical characteristics, work-up studies, and clinical scales including National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) scores were examined retrospectively. All patients diagnosed with acute stroke who were also evaluated for COVID-19 before hospitalization were divided into two groups: COVID-19-related and unrelated cases.
Results: COVID-19-related and unrelated acute stroke patients had similar characteristics in terms of age, gender, and stroke risk factors. The admission NIHSS (mean NIHSS: 9.8 vs. 5.9) scores and the discharge mRS values (mean mRS: 3.9 vs. 2.4) were significantly higher in the COVID-19-related stroke group (p=0.002 and p=0.001, respectively). The prognosis of the COVID-19-related stroke group was significantly worse (69.6% vs. 39.8%) and the mortality rate (39.1% vs. 6.2%) was significantly higher than the COVID-19-unrelated stroke group (p=0.007 vs. p=0.000, respectively). The proportion of patients with large infarcts in the COVID-19-related acute ischemic stroke group was significantly higher than the one in the COVID-19-unrelated acute ischemic stroke group (57.9% vs. 21.9%, p=0.003).
Conclusion: This is the first comparative study to evaluate the clinical presentation and outcome of COVID-19-related acute ischemic and hemorrhagic stroke patients in Turkey. Our results suggest that COVID-19-related acute stroke is associated with more severe clinical presentation and worse outcome. This seems to be linked to the coagulation abnormalities induced by COVID-19 infection.

COVID-19 Pandemi Döneminde COVID-19 Ýliþkili ve Ýliþkisiz Akut Ýnme Hastalarýnýn Klinik Özelliklerinin Karþýlaþtýrýlmasý

Amaç: Ýnme ve Coronavirus hastalýðý 2019 (COVID-19) enfeksiyonunun birlikte görülmesine iliþkin sýnýrlý sayýda veri bulunmaktadýr. Çalýþmamýzda, merkezimize akut inme ile baþvuran COVID-19 iliþkili hastalarýn klinik ve laboratuvar özelliklerinin deðerlendirilmesi ve ayný dönem içerisinde COVID-19 enfeksiyonu olmayan akut inme hastalarý ile kýyaslanmasý amaçlanmýþtýr.
Gereç ve Yöntemler: Merkezimize 11 Mart 2020 ile 11 Mayýs 2020 tarihleri arasýnda akut inme ile baþvuran 184 hasta çalýþmaya dahil edildi. Olgularýn demografik ve klinik özellikleri, tanýya ve etiyolojiye yönelik yapýlmýþ olan tetkikleri ile NIHSS (National Institutes of Health Stroke Scale), mRS (modified Rankin scale) skorlarý retrospektif olarak incelendi. Yatýþ öncesi COVID-19 açýsýndan deðerlendirilen tüm akut inme tanýlý hastalar, COVID-19 iliþkili olan ve olmayan olgular olmak üzere iki gruba ayrýldý.
Bulgular: COVID-19 iliþkili olan ve olmayan hastalar yaþ, cinsiyet ve inme risk faktörleri açýsýndan karþýlaþtýrýldýðýnda her iki grup benzer özelliklere sahipti. COVID-19 iliþkili akut inme grubunda giriþ NIHSS ve çýkýþ mRS skorlarý COVID-19 iliþkisiz inme grubundan anlamlý olarak daha yüksekti (sýrasýyla 9,8 vs 5,9; p=0,002 ve 3,9 vs 2,4; p=0,001). COVID-19 iliþkili inme grubunun prognozu COVID-19 iliþkisiz inme grubundan anlamlý derecede daha kötü ve mortalite oraný da anlamlý derecede daha yüksekti (sýrasýyla %69.6 vs %39.8; p=0,007 ve %39,1 vs %6,2; p=0,000). COVID-19 iliþkili akut iskemik inme grubunda büyük enfarktý olan hastalarýn oraný, COVID-19 iliþkisiz akut iskemik inme grubundan anlamlý derecede daha yüksekti (%57,9 vs %21,9 p=0,003).
Sonuç: Çalýþmamýz, Türkiye'de COVID-19 ile iliþkili akut iskemik ve hemorajik inme hastalarýnýn klinik prezantasyonunu ve sonuçlarýný deðerlendiren ilk çalýþmadýr. Bulgularýmýz COVID-19 iliþkili akut inmenin daha aðýr klinik prezentasyon ve daha kötü sonlaným ile iliþkili olduðunu düþündürmektedir. Bu durum COVID-19 enfeksiyonunun arttýrdýðý koagülasyon anormallikleri ile baðlantýlý görünmektedir. (SETB-2021-05-127)