Clinical Symptoms and Treatment Outcomes of COVID-19 Patients with Stroke

Oskar Yuda Daud, Robert Sinurat

Abstract


Background: COVID-19 patients who come to the emergency room often suffer from stroke. This study aimed to examine clinical symptoms and treatment outcomes of COVID-19 patients with stroke.

Methods: This study was a retrospective study using secondary data from medical records of COVID-19 patients with stroke, hospitalized at the Universitas Kristen Indonesia Hospital, Jakarta, Indonesia for the period 2020–2022. Patients with PCR test positive for COVID-19 who had clinical symptoms of stroke, confirmed by  CT scan showing brain ischemic or hemorrhage were included. Data on gender, age, Glasgow coma scale (GCS), subtype of stroke, severity of COVID-19, and outcome were recorded and analyzed using paired t-test and the Spearman correlation.

Results: Of the 49 patients included, 91.8% were over 45 years old and suffered from severe COVID-19. Men were slightly more (51.1%) than women and 93.9% of patients suffered from ischemic stroke. The GCS scores of 46.9% of patients decreased significantly during hospitalization (p=0.02). Most of patients (65.3%) had used non-rebreathing mask (NRM), 10.2% ventilators, and others used nasal cannulas. As many as 46.9% of patients died, 44.9% recovered with neurological deficits, and only 8.2% recovered completely. Interestingly, oxygen delivery devices were significantly correlated with outcome (p=0.00). Patients receiving the antiviral favipiravir had better outcomes compared with those taking remdesivir (p=0.021).

Conclusion: The mortality rate for stroke patients with severe COVID-19 is high, and the outcome of patients using NRM or ventilator is worse than patients using nasal cannulas. The antiviral Favipiravir has better outcomes for stroke patients with severe COVID-19.


Keywords


COVID-19, favipiravir, outcome, stroke, treatment

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References


  1. Nannoni S, de Groot R, Bell S, Markus HS. Stroke in COVID-19: a systematic review and meta-analysis. Int J Stroke. 2021;16(2):137–49.
  2. Spence JD, de Freitas GR, Pettigrew LC, Ay H, Liebeskind DS, Kase CS, et al. Mechanisms of stroke in COVID-19. Cerebrovasc Dis. 2020;49(4):451–8.
  3. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.
  4. Cheng R, Leedy G. COVID-19 and acute myocardial injury: the heart of the matter or an innocent bystander. Heart. 2020;106(15):1122–4.
  5. Martí-Fàbregas J, Guisado-Alonso D, Delgado-Mederos R, Martínez-Domeño A, Prats-Sánchez L, Guasch-Jiménez M, et al. Impact of COVID-19 infection on the outcome of patients with ischemic stroke. Stroke. 2021;52(12):3908–17.
  6. Akhtar N, Abid F, Singh R, Kamran S, Imam Y, Al-Jerdi S, et al. Ischemic stroke in patients that recover from COVID-19: comparisons to historical stroke prior to COVID-19 or stroke in patients with active COVID-19 infection. PLoS One. 2022;17(6):e0270413.
  7. Ruksakulpiwat S. The impact of COVID-19 on patients with stroke: an integrative review. J Health Res. 2021;36(4):652-62.
  8. Qureshi AI, Baskett WI, Huang W, Myers D, Lobanova I, Ishfaq MF, et al. Intracerebral hemorrhage and coronavirus disease 2019 in a cohort of 282,718 hospitalized patients. Neurocrit Care. 2022;36(1):259–65.
  9. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan Republik Indonesia. Hasil utama RISKEDAS 2018. [Cited 2022 October 10]. Available from: https://www.litbang.kemkes.go.id/laporan-riset-kesehatan-dasar-riskesdas/
  10. World Stroke Organization (WSO). Global stroke fact sheet 2022. [Cited 2022 October 10]. Available from: https://www.dropbox.com/scl/fi/f9c3n8jlirq85ohts6t8m/WSO-Global-Stroke-Factsheet 09-02.2022.ppt?dl=0&rlkey=grvocqyp5ivr1bxgpvfah134m.
  11. Syahrul S, Maliga AH, Ilmawan M, Fahriani M, Mamada SS, Fajar JK, et al. Hemorrhagic and ischemic stroke in patients with coronavirus disease 2019: incidence, risk factors, and pathogenesis-a systematic review and meta-analysis. F1000Res. 2021;10:34.
  12. Göz E, Kahraman T, Genc A, Kaya Ö, Öztürk V, Kutluk K. Factors affecting hospital length of stay among patients with acute stroke. J Neurol Sci [Turkish]. 2017;34(2):143–52.
  13. Li X, Zhong X, Wang Y, Zeng X, Luo T, Liu Q. Clinical determinants of the severity of COVID-19: a systematic review and meta-analysis. PLoS One. 2021;16(5):e0250602.
  14. Feng Y, Ling Y, Bai T, Xie Y, Huang J, Li J, et al. COVID-19 with different severities: a multicenter study of clinical features. Am J Respir Crit Care Med. 2020:201(11):1380–8.
  15. Gattringer T, Posekany A, Niederkorn K, Knoflach M, Poltrum B, Mutzenbach S, et al. Predicting early mortality of acute ischemic stroke. Stroke. 2019;50(2):349–56.
  16. Riptasari RD, Rahem A, Purnamayanti A. Perbandingan keberhasilan terapi antivirus favipiravir dan remdesivir pada pasien COVID-19 di RSUD dr. Doris Sylvanus. Jurnal Surya Medika. 2022;8(1):125–8.
  17. Damayanti H, Sajinadiyasa IGK, Risni HW, Sauriasari R. The effectiveness and safety of favipiravir in COVID-19 hospitalized patients at tertiary referral hospital, Bali, Indonesia. Kesmas. 2021;16(4):289–97.
  18. Joshi S, Parkar J, Ansari A, Vora A, Talwar D, Tiwaskar M, et al. Role of favipiravir in the treatment of COVID-19. Int J Infect Dis. 2021;102: 501–8.
  19. Marti S, Carsin AE, Sampol J, Pallero M, Aldas I, Marin T, et al. Higher mortality and intubation rate in COVID-19 patients treated with noninvasive ventilation compared with high-flow oxygen or CPAP. Sci Rep. 2022;12(1):6527.
  20. Magleby R, Westblade LF, Trzebucki A, Simon MS, Rajan M, Park J, et al. Impact of severe acute respiratory syndrome coronavirus 2 viral load on risk of intubation and mortality among hospitalized patients with coronavirus disease 2019. Clin Infect Dis. 2021;73(11):e4197–205.




DOI: https://doi.org/10.15850/amj.v11n1.3120

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