Abstract Details

Title Characteristics and Outcomes of Stroke Patients with Concurrent SARS-CoV-2 Infection from March 1, 2020 to February 28, 2021: An Analysis from the N3C Database

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-007

Background Studies have shown that patients with ischemic stroke (IS) and concurrent COVID-19 have increased stroke severity. These analyses were limited by use of prepandemic era controls or by use of a sample from the early pandemic when stroke care delivery was affected by lockdown. Data on the severity of hemorrhagic stroke (HS) in patients with COVID-19 are sparse.

Objective To test the association of SARS-CoV-2 infection with increased stroke severity in individuals with ischemic and hemorrhagic stroke during the first year of the COVID-19 pandemic in the US.

Design/Methods Using the National Institute of Health (NIH) National COVID Cohort Collaborative (N3C) database, we identified patients diagnosed with stroke between Mar 1, 2020 - Feb 28, 2021. Hospitalized stroke patients with concurrent COVID-19 (stroke within 3 months after or one week prior to positive SARS-CoV-2 PCR or AG lab test) were matched to all other hospitalized stroke patients in a 1:3 ratio. Nearest neighbor matching with a caliper of 0.25 was used for most clinical and demographic factors; exact matching for race/ethnicity and site. Within our matched sample, we used Poisson regression to calculate stroke severity incident rate ratio (IRR).

Results Our query identified 10394 patients hospitalized with IS with NIHSS scores upon admission (802 with concurrent COVID-19 and 9592 without) and 2138 patients hospitalized with HS with admission NIHSS scores (181 with concurrent COVID-19 and 1957 without). Average NIHSS was greater in concurrent groups with both IS and HS (11.1 vs 7.68, p<0.001 and 15.7 vs 11.7, p<0.001 respectively). Propensity matched analysis demonstrated that stroke patients with concurrent COVID-19 had increased NIHSS (IS: IRR=1.4, 95% CI:1.3-1.5, p<0.001; HS: IRR=1.3, 95% CI:1.2-1.5, p<0.001).

Conclusions This analysis suggests that the association between increased stroke severity and COVID-19 remained as stroke care utilization normalized. Further work will center on the interaction between COVID-19 illness severity and stroke severity.

Authors/Disclosures
Jackson A. Narrett, MD (Yale New Haven Hospital) PRESENTER	Mr. Narrett has nothing to disclose.
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Ofer Sadan	Ofer Sadan has received intellectual property interests from a discovery or technology relating to health care.
Teshamae Monteith, MD, FAAN (University of Miami)	Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for American Headache Society . Dr. Monteith has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for e-Neura. Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Monteith has received personal compensation in the range of $0-$499 for serving as a Consultant for Merz. Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Teva . Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN . Dr. Monteith has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Monteith has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN . The institution of Dr. Monteith has received research support from AbbVie. The institution of Dr. Monteith has received research support from Amgen. The institution of Dr. Monteith has received research support from lilly. The institution of Dr. Monteith has received research support from Ipsen. Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as a Education with Medscape. Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as a Education with Massachusetts Medical Society . Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as a Education with Academic CME. Dr. Monteith has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Neuodiem. Dr. Monteith has a non-compensated relationship as a President Elect with Florida Society of Neurology that is relevant to AAN interests or activities. Dr. Monteith has a non-compensated relationship as a Editorial Board with American Migraine Foundation that is relevant to AAN interests or activities. Dr. Monteith has a non-compensated relationship as a Board Member with International Headache Society that is relevant to AAN interests or activities. Dr. Monteith has a non-compensated relationship as a author with Pfizer that is relevant to AAN interests or activities. Dr. Monteith has a non-compensated relationship as a author with Abbvie that is relevant to AAN interests or activities. Dr. Monteith has a non-compensated relationship as a author with Theranica that is relevant to AAN interests or activities.
Bradford B. Worrall, MD, MSc, FAAN (University Of Virginia Health System)	The institution of Dr. Worrall has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Worrall has received research support from NIH.
	No disclosure on file
Karen C. Johnston, MD, MSC (University of Virginia)	Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University of Pittsburg. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mayo Clinic. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University of California Irvine. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NIH. Dr. Johnston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FDA. The institution of Dr. Johnston has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. The institution of Dr. Johnston has received research support from NIH.
Andrew M. Southerland, MD, FAAN (University of Virginia, Dept of Neurology)	Dr. Southerland has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Plaintiffs and Defense Cases related to Stroke and Vascular Neurology.. The institution of Dr. Southerland has received research support from American Heart Association. The institution of Dr. Southerland has received research support from NIH. The institution of Dr. Southerland has received research support from Abbvie Pharmaceuticals, Inc.. Dr. Southerland has received intellectual property interests from a discovery or technology relating to health care. Dr. Southerland has received intellectual property interests from a discovery or technology relating to health care.