# Impact of COVID-19 on ischemic stroke patterns and outcomes: a multicenter retrospective study using propensity score matching

## TL;DR

The study found that patients with ischemic stroke and COVID-19 had worse outcomes, including higher risks of pneumonia, cognitive impairment, and in-hospital death, compared to those without COVID-19.

## Contribution

This is the first multicenter study in the Middle East to use propensity score matching to assess the impact of COVID-19 on ischemic stroke outcomes.

## Key findings

- Patients with ischemic stroke and COVID-19 had significantly longer hospital stays and higher rates of pneumonia, cognitive impairment, and in-hospital mortality.
- After adjusting for baseline factors, COVID-19 was independently associated with increased odds of pneumonia, cognitive impairment, and in-hospital death.
- The study highlights the need for intensified monitoring of high-risk stroke patients during infectious disease outbreaks.

## Abstract

The impact of coronavirus disease 2019 (COVID-19) on ischemic stroke outcomes remains uncertain, particularly in multicenter Middle Eastern cohorts. This study aimed to assess stroke-related complications and in-hospital outcomes in patients with and without COVID-19 using a propensity score–matched design.

We retrospectively analyzed 820 ischemic stroke patients admitted to three tertiary hospitals in Saudi Arabia between March 2020 and March 2021. Among these patients, 711 had no COVID-19, and 109 had confirmed COVID-19. Propensity score matching (2:1) was performed on the basis of age, sex, smoking status, diabetes status, hypertension status, and ischemic heart disease, resulting in a matched cohort of 327 patients (218 non-COVID-19 patients and 109 COVID-19 patients). Clinical outcomes were compared via conditional logistic regression.

After matching, COVID-19 patients had significantly longer hospital stays (median 5 vs. 3 days, p = 0.044) and higher rates of pneumonia (54.1% vs. 10.6%, p < 0.001), cognitive impairment (11.9% vs. 2.8%, p = 0.001), and in-hospital mortality (23.9% vs. 10.1%, p = 0.001). COVID-19 infection was significantly associated with pneumonia (OR = 10.88; 95% CI: 5.36–22.08, p < 0.001), cognitive impairment (OR = 5.81; 95% CI: 1.87–18.00, p = 0.002), and in-hospital death (OR = 2.98; 95% CI: 1.53–5.79, p = 0.001).

COVID-19 infection independently worsens ischemic stroke outcomes, increasing the risk of pneumonia, cognitive impairment, and in-hospital mortality even after adjustment for baseline factors. These findings highlight the need for intensified respiratory and neurological monitoring and may guide the clinical prioritization of high-risk stroke patients during infectious disease outbreaks.

This was a multicenter retrospective study examining the clinical outcomes and mortality of ischemic stroke patients with and without COVID-19 after propensity score matching (N = 327: 218 without COVID-19, 109 with COVID-19). Patients with ischemic stroke and COVID-19 had greater odds of pneumonia (OR = 10.88, 95% CI: 5.36–22.08, p < 0.001), cognitive impairment (OR = 5.81, 95% CI: 1.87–18.00, p = 0.002), and in-hospital death (OR = 2.98, 95% CI: 1.53–5.79, p = 0.001) than those without COVID-19.Multicenter retrospective study comparing clinical outcomes and mortality in ischemic stroke patients with and without COVID-19. Includes 218 patients without COVID-19 and 109 with COVID-19. Increased risk in COVID-19 group: pneumonia (odds ratio: 10.88), cognitive impairment (odds ratio: 5.81), and in-hospital death (odds ratio: 2.98). Propensity score matching is used.

This was a multicenter retrospective study examining the clinical outcomes and mortality of ischemic stroke patients with and without COVID-19 after propensity score matching (N = 327: 218 without COVID-19, 109 with COVID-19). Patients with ischemic stroke and COVID-19 had greater odds of pneumonia (OR = 10.88, 95% CI: 5.36–22.08, p < 0.001), cognitive impairment (OR = 5.81, 95% CI: 1.87–18.00, p = 0.002), and in-hospital death (OR = 2.98, 95% CI: 1.53–5.79, p = 0.001) than those without COVID-19.