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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Recurrent stroke admissions with vs without COVID-19 and associated in-hospital mortality: A United States nationwide analysis, 2020
Rupak Desai, Sai Priyanka Mellacheruvu, Sai Anusha Akella, Adil Sarvar Mohammed, Mushfequa Hussain, Abdul Aziz Mohammed, Pakhal Saketha, Praveena Sunkara, Jyotsna Gummadi, Paritharsh Ghantasala
Rupak Desai, Outcomes Research, Independent Researcher, Atlanta, GA 30033, United States
Sai Priyanka Mellacheruvu, Department of Public Health, University of Massachusetts, Lowell, MA 01854, United States
Sai Anusha Akella, Department of Internal Medicine, One Brooklyn Health- Interfaith Medical Center, Brooklyn, NY 11213, United States
Adil Sarvar Mohammed, Paritharsh Ghantasala, Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48602, United States
Mushfequa Hussain, Abdul Aziz Mohammed, Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India
Pakhal Saketha, Department of Internal Medicine, Bhaskar Medical College, Moinabad 500075, Hyderabad, India
Praveena Sunkara, Department of Internal Medicine, MedStar Medical Group, Charlotte Hall, MD 20622, United States
Jyotsna Gummadi, Department of Medicine, Medstar Franklin Square Medical Center, Baltimore, MD 21237, United States
Author contributions: Desai R and Mellacheruvu SP designed the research study; Akella SA, Mohammed AS, Hussain M, Mohammed AA, and Desai R performed the research; Akella SA, Mohammed AS, Mellacheruvu SP, Saketha P, and Sunkara P analyzed the data and wrote the manuscript; Gummadi J, Ghantasala P, and Desai R reviewed and edited the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: Since the data included in this review were de-identified and already available in publicly accessible databases, the IRB review was not mandatory. This review was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: No written consent has been obtained from the patients, as no patient-identifiable data from the NIS database is included in this observational study.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: Not applicable.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Adil Sarvar Mohammed, MD, Doctor, Department of Internal Medicine, Central Michigan University College of Medicine, 1632 Stone Street, Saginaw, MI 48602, United States.
s.aadil19@gmail.com
Received: May 8, 2024
Revised: June 12, 2024
Accepted: July 10, 2024
Published online: September 25, 2024
Processing time: 113 Days and 11 Hours
BACKGROUND
Coronavirus disease 2019 (COVID-19) has been shown to increase the risk of stroke. However, the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack (TIA), as well as its impact on mortality, are not established.
AIM
To evaluate the impact of COVID-19 on in-hospital mortality, length of stay, and healthcare costs in patients with recurrent strokes.
METHODS
We identified admissions of recurrent stroke (current acute ischemic stroke admissions with at least one prior TIA or stroke) in patients with and without COVID-19 using ICD-10-CM codes using the National Inpatient Sample (2020). We analyzed the impact of COVID-19 on mortality following recurrent stroke admissions by subgroups.
RESULTS
Of 97455 admissions with recurrent stroke, 2140 (2.2%) belonged to the COVID-19-positive group. The COVID-19-positive group had a higher prevalence of diabetes and chronic kidney disease vs the COVID-19 negative group (P < 0.001). Among the subgroups, patients aged > 65 years, patients aged 45–64 years, Asians, Hispanics, whites, and blacks in the COVID-19 positive group had higher rates of all-cause mortality than the COVID-19 negative group (P < 0.01). Higher odds of in-hospital mortality were seen in the group aged 45-64 (OR: 8.40, 95%CI: 4.18-16.91) vs the group aged > 65 (OR: 7.04, 95%CI: 5.24-9.44), males (OR: 7.82, 95%CI: 5.38-11.35) compared to females (OR: 6.15, 95%CI: 4.12-9.18), and in Hispanics (OR: 15.47, 95%CI: 7.61-31.44) and Asians/Pacific Islanders (OR: 14.93, 95%CI: 7.22-30.87) compared to blacks (OR: 5.73, 95%CI: 3.08-10.68), and whites (OR: 5.54, 95%CI: 3.79-8.09).
CONCLUSION
The study highlights the increased risk of all-cause in-hospital mortality in recurrent stroke patients with COVID-19, with a more pronounced increase in middle-aged patients, males, Hispanics, or Asians.
Core Tip: This study underscores the enhanced all-cause in-hospital mortality risk among recurrent stroke patients who test positive for coronavirus disease 2019 (COVID-19). Notably, the increased mortality risk is most significant in middle-aged individuals (45-64 years), males, and ethnic minorities, including Hispanics and Asians. Data from the National Inpatient Sample in 2020 revealed that COVID-19 patients with prior stroke or transient ischemic attack exhibit higher mortality compared to non-COVID-19 counterparts, alongside a greater prevalence of comorbidities such as diabetes and chronic kidney disease. These findings emphasize the critical need for targeted management strategies in these high-risk groups.
