Degree of COVID-19 Severity and Mortality in Stroke: Correlation of Clinical and Laboratory Parameters

Background: Stroke is one of the neurological manifestations of COVID-19. Acute stroke patients with COVID-19 had a significant morbidity and mortality. The clinical and laboratory data of these patients were investigated to determine the key factors in predicting mortality. Method This retrospective case-control study was conducted at Dr. Sardjito General Hospital Yogyakarta, Indonesia using data from July 2020 - August 2021. All acute stroke patients with confirmed COVID-19 were included. Patients’ medical records were used to collect the clinical and laboratory data. For baseline characteristics, univariate tests were used, followed by bivariate and multivariate analyses to determine significant predictors of mortality. Result We included a total of 72 subjects, consisting of 65 (90.28%) subjects with ischemic stroke and 7 (9.72%) with hemorrhagic stroke. The overall mortality rate was 58.3%, which consisted of 50% ischemic and 8.3% hemorrhagic stroke cases. Lowered Glasgow Coma Scale (GCS), loss of consciousness, generalized seizures, worsened modified Ranking Scale (mRS), history of dyslipidemia, worsened clinical severity of COVID-19 infection, respiratory distress, higher neutrophil count, C-Reactive Protein levels (> 41mg/dl), Blood Urea Nitrogen (> 29.05mg/dl), and Random Blood Glucose level (> 111.5mg/dl) at admission were all significantly associated with mortality ( p  < 0.05). Cox regression analysis revealed a 17.535 higher risk of mortality in individuals with severe COVID-19 ( p  = 0.032). Higher mRS scores more than doubled the probability of mortality ( p  = 0.001). Conclusion The poorer functional status assessed by mRS and the greater degree of COVID-19 on admission should be carefully identified since they may increase the risk of mortality in stroke patients with COVID-19.