AUTHOR=Wang Minghuan , Zhang Han , He Yuqin , Qin Chuan , Liu Xingyuan , Liu Mingqian , Tang Yuhong , Li Xiaohua , Yang Guang , Tang Yingxin , Liang Gang , Xu Shabei , Wang Wei 

TITLE=Association Between Ischemic Stroke and COVID-19 in China: A Population-Based Retrospective Study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.792487

DOI=10.3389/fmed.2021.792487

ISSN=2296-858X

ABSTRACT=BACKGROUND AND PURPOSE: To investigate the effect of prior ischemic stroke on the outcomes of patients hospitalized with COVID-19, and to describe the incidence, clinical features and risk factors of acute ischemic stroke (AIS) following COVID-19. 
METHODS: In this population-based retrospective study, we included all the COVID-19 positive hospitalized patients at Wuhan City from Dec 29, 2019 to April 15, 2020. Clinical data was extracted from administrative datasets coordinated by the Wuhan Health Commission. Propensity score matching and multivariate logistic regression analyses were  used to adjust the confounding factors.
RESULTS: There are 36,358 patients in the final cohort, in which 1160 (3.2%) had a prior stroke. After adjusting for available baseline characteristics, patients with prior stroke had a higher proportion of severe and critical illness and mortality. We found for the first time that premorbid MRS grouping (OR=1.796 [95%CI 1.334-2.435], p<0.001) and older age (OR=1.905 [95%CI 1.211-3.046], p=0.006) imparted increased risk of death. AIS following COVID-19 occurred in 124 (0.34%) cases, and patients with prior stroke had a much higher incidence of AIS (3.4%). Logistic regression analyses confirmed an association between severity of COVID-19 with the incidence of AIS. COVID-19 patients with AIS had a significantly higher mortality compared with COVID-19 patients without stroke and AIS patients without COVID-19.
CONCLUSIONS: COVID-19 patients with prior stroke, especially those with higher premorbid MRS or aged, have worse clinical outcomes. Furthermore, COVID-19 increases the incidence of AIS, and the incidence is positively associated with the severity of COVID-19.