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23/11/2021 - Covid-19

Having suffered a stroke increases the risk of dying after surviving COVID-19 by up to three times.

The data comes from more than 90,000 people diagnosed with COVID-19 in Catalonia up to July last year. More than 6% had suffered a stroke at some point before infection. People under the age of 60 who have suffered a stroke prior to contracting COVID-19 are three times more likely to die than those who have never suffered a stroke. This risk drops to 1.3 times in people aged between 60 and 80 and is not significant in those over 80. The researchers point out that this needs to be taken into account when determining COVID-19 vaccination priorities. The study is published in the journal Stroke. It is the first study of its kind in Spain and one of the first in the world.

Being under 60 years old and having suffered some type of stroke makes it three times more likely you will die after suffering COVID-19. For people aged between 60 and 80, this risk is still 1.3 times higher than people in the same age group who have not suffered a stroke. This is the conclusion of the first population-based study carried out in Spain on the relationship between mortality after suffering COVID-19 and having suffered a stroke, and it is one of only a handful of studies to date in the world. The researchers are doctors and researchers from the Neurology Service of Hospital del Mar and the Neurovascular Research Group of the Hospital del Mar Medical Research Institute (IMIM-Hospital del Mar).  The study has been published in the journal Stroke.

The work involved analysing data from all the people infected by the SARS-CoV-2 coronavirus in Catalonia between 1 February, 2020, and 1 July, 2020, thanks to the data analytics programme for research and innovation in health (PADRIS), which is managed by the Catalan Health Quality and Assessment Agency (AQuAS) of the Catalan Government's Department of Health. In total it included 91,629 people, of whom 5,752, or 6.27%, had suffered a stroke prior to infection. Of these, 30% died after suffering COVID-19, compared to 9% in the group of patients who had not suffered a stroke before contracting the disease. Everyone included in the analysis was monitored up until the end of 2020.

"Everything points to the fact that mortality increases after COVID-19 in this group, as they suffer a greater degree of disability as a result of the stroke, in other words, they have, among other things, mobility problems so that, in the case of an infection, it is more likely to be more serious at a respiratory level, as they have greater problems breathing and swallowing", explains Dr. Elisa Cuadrado, a consultant in the Neurology Service, main author of the study and an IMIM-Hospital del Mar researcher. For that reason, "It is the secondary disability related to stroke that we believe puts stroke sufferers at a higher risk of having a more severe COVID-19 infection and dying, or having more complications from the infection", concludes Dr. Cuadrado.

From left to right, Angel Ois, Elisa Cuadrado Godia, Uxue Lazcano, Ana Rodriguez Campello and Jaume Roquer.

Greater risk in patients under sixty years of age

The study concludes that, contrary to what might be expected, the risk is higher in the youngest group of people who have suffered a stroke, those under 60 years of age. It is also high in the group aged 60 and 70, but is not significant in those over 80 years of age, probably because they suffer from other chronic illnesses. On the other hand, no differences were found between men and women.

At the same time, the risk is higher if you have previously had a haemorrhagic stroke, a particular type that involves a greater number of sequelae. In this group, the risk is five times higher among younger people, and twice as high among those aged between 70 and 80. In the case of people who have suffered an ischaemic stroke, the risk is three times higher if they are under 60 years of age, and 1.3 times higher if they are between 70 and 80. For patients who have suffered a subarachnoid haemorrhage, the risk is five times higher among younger people, as this is a more common type of stroke in people in this age bracket. In cases of transient ischaemic stroke, which is milder and may have fewer sequelae, no increased risk of mortality has been detected. The researchers were also able to establish that the length of time between the stroke and the COVID-19 infection is influential, with more recent cases carrying a higher risk.

For all the stated reasons, the researchers argue that in terms of COVID-19 vaccination policies, priority should be given to people aged under 60 who have suffered a stroke. "A person under 70 years of age who has suffered a stroke prior to infection with COVID-19, who has a disability caused by this previous pathology, should be considered part of the at-risk population and prioritised in COVID-19 vaccination policies", stresses Dr. Àngel Ois, the last author of the study, a consultant in the Neurology Service and also a researcher at IMIM-Hospital del Mar. Dr. Jaume Roquer, head of the Neurology Service and coordinator of the Neurovascular Research Group at IMIM-Hospital del Mar, adds that "The data from this study provides new evidence of the social and health importance of cerebrovascular disease as well as the need to continue improving prevention and treatment in terms of this pathology."

The study is the result of one of the sixty projects presented in the PADRIS programme's project prioritisation. As Uxue Lazcano, first author of the study and a researcher at the IMIM and AQuAS, points out, "It has been very interesting to go from designing the project based on the shortcomings of previous studies to extracting "live" data in the midst of the pandemic. We have experienced the synergy between the more applied/clinical world, thanks to Dr. Cuadrado and Dr. Ois, with their extensive expertise in treating stroke, and our experience from PADRIS studies using current COVID-19 data, enabling us to carry out a high quality study employing population-based data."

Reference article

Increased COVID-19 Mortality in People With Previous Cerebrovascular Disease: A Population-Based Cohort Study

Uxue LazcanoMSc, Elisa Cuadrado-GodiaMD, PhD, María GrauMD, PhD, Isaac Subirana, MStat, PhD, Elisenda Martínez-Carbonell, MStat, Marc Boher-Massaguer, MSc, Ana Rodríguez-CampelloMD, PhD, Eva Giralt-SteinhauerMD, PhD, Isabel Fernández-PérezMD, Jordi Jiménez-Conde, MD, PhD, Jaume RoquerMD, PhD, Ángel OisMD, PhD

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