Prevalence and impact of SARS-CoV-2 infection among patients with acute ischaemic stroke: a nationwide register-based cohort study in Denmark

Janne Kaergaard Mortensen; Rolf Ankerlund Blauenfeldt; Jakob Nebeling Hedegaard; Christian Morberg Wejse; Søren Paaske Johnsen; Grethe Andersen; Claus Ziegler Simonsen

doi:10.1136/bmjopen-2023-081527

Prevalence and impact of SARS-CoV-2 infection among patients with acute ischaemic stroke: a nationwide register-based cohort study in Denmark

Janne Kaergaard Mortensen^*, Rolf Ankerlund Blauenfeldt, Jakob Nebeling Hedegaard, Christian Morberg Wejse, Søren Paaske Johnsen, Grethe Andersen, Claus Ziegler Simonsen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

OBJECTIVES: An increased risk of stroke has been reported among patients with COVID-19 caused by SARS-CoV-2. We aimed to investigate the nationwide prevalence of SARS-CoV-2 among patients with acute ischaemic stroke and to study the impact on stroke severity, quality of care and mortality on an individual patient level.

DESIGN: This was a nationwide register-based cohort study.

SETTING: We used data from several Danish registers which were linked at an individual patient level using the unique civil registration number assigned to all Danish citizens. Patients were identified from the Danish Stroke Registry and information on SARS-CoV-2 infection status was collected from the Danish National COVID-19 Registry. Concurrent SARS-CoV-2 infection was defined as a positive PCR test within 31 days prior to, and 1 day after, stroke admission. Information on comorbidity was collected from the Danish National Patient Registry and information on vital status was collected from the Danish Civil Registration System.

PARTICIPANTS: A total of 11 502 patients admitted with acute ischaemic stroke from 10 March 2020 to 31 May 2021 were included in the study.

RESULTS: Among the included patients, the majority (84.6%) were tested for SARS-CoV-2, but only 68 had a positive test. These patients were more prone to have atrial fibrillation and were more often treated with reperfusion therapy. They had a significantly increased risk of severe stroke (adjusted relative risk (aRR) 1.93, 95% CI: 1.22 to 3.04) and a significantly increased 30-day mortality risk (aRR 2.29, 95% CI: 1.19 to 4.39). There was no difference in the proportion of patients fulfilling relevant performance measures on quality of care.

CONCLUSION: In this nationwide study, only 0.6% of patients with acute ischaemic stroke were tested positive for a concurrent SARS-CoV-2 infection. The patients with SARS-CoV-2 presented with more severe strokes.

Original language	English
Article number	e081527
Journal	BMJ Open
Volume	14
Issue number	3
Number of pages	7
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2023-081527
Publication status	Published - 28 Mar 2024

Bibliographical note

Keywords

Humans
COVID-19
SARS-CoV-2
Cohort Studies
Brain Ischemia/complications
Prevalence
Stroke/epidemiology
Ischemic Stroke/epidemiology
Denmark/epidemiology

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Mortensen et al. (2024). Prevalence and impact of SARS-CoV-2 infection among patients with acute ischaemic stroke: a nationwide register-based cohort study in DenmarkFinal published version, 862 KBLicence: CC BY-NC 4.0

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@article{76b90837cc36473d8248de1c3909bfe2,

title = "Prevalence and impact of SARS-CoV-2 infection among patients with acute ischaemic stroke: a nationwide register-based cohort study in Denmark",

abstract = "OBJECTIVES: An increased risk of stroke has been reported among patients with COVID-19 caused by SARS-CoV-2. We aimed to investigate the nationwide prevalence of SARS-CoV-2 among patients with acute ischaemic stroke and to study the impact on stroke severity, quality of care and mortality on an individual patient level.DESIGN: This was a nationwide register-based cohort study.SETTING: We used data from several Danish registers which were linked at an individual patient level using the unique civil registration number assigned to all Danish citizens. Patients were identified from the Danish Stroke Registry and information on SARS-CoV-2 infection status was collected from the Danish National COVID-19 Registry. Concurrent SARS-CoV-2 infection was defined as a positive PCR test within 31 days prior to, and 1 day after, stroke admission. Information on comorbidity was collected from the Danish National Patient Registry and information on vital status was collected from the Danish Civil Registration System.PARTICIPANTS: A total of 11 502 patients admitted with acute ischaemic stroke from 10 March 2020 to 31 May 2021 were included in the study.RESULTS: Among the included patients, the majority (84.6%) were tested for SARS-CoV-2, but only 68 had a positive test. These patients were more prone to have atrial fibrillation and were more often treated with reperfusion therapy. They had a significantly increased risk of severe stroke (adjusted relative risk (aRR) 1.93, 95% CI: 1.22 to 3.04) and a significantly increased 30-day mortality risk (aRR 2.29, 95% CI: 1.19 to 4.39). There was no difference in the proportion of patients fulfilling relevant performance measures on quality of care.CONCLUSION: In this nationwide study, only 0.6% of patients with acute ischaemic stroke were tested positive for a concurrent SARS-CoV-2 infection. The patients with SARS-CoV-2 presented with more severe strokes.",

keywords = "Humans, COVID-19, SARS-CoV-2, Cohort Studies, Brain Ischemia/complications, Prevalence, Stroke/epidemiology, Ischemic Stroke/epidemiology, Denmark/epidemiology",

author = "Mortensen, {Janne Kaergaard} and Blauenfeldt, {Rolf Ankerlund} and Hedegaard, {Jakob Nebeling} and {Morberg Wejse}, Christian and Johnsen, {S{\o}ren Paaske} and Grethe Andersen and Simonsen, {Claus Ziegler}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2024",

month = mar,

day = "28",

doi = "10.1136/bmjopen-2023-081527",

language = "English",

volume = "14",

journal = "BMJ Open",

issn = "2044-6055",

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Prevalence and impact of SARS-CoV-2 infection among patients with acute ischaemic stroke: a nationwide register-based cohort study in Denmark. / Mortensen, Janne Kaergaard; Blauenfeldt, Rolf Ankerlund; Hedegaard, Jakob Nebeling et al.
In: BMJ Open, Vol. 14, No. 3, e081527, 28.03.2024.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Prevalence and impact of SARS-CoV-2 infection among patients with acute ischaemic stroke: a nationwide register-based cohort study in Denmark

AU - Mortensen, Janne Kaergaard

AU - Blauenfeldt, Rolf Ankerlund

AU - Hedegaard, Jakob Nebeling

AU - Morberg Wejse, Christian

AU - Johnsen, Søren Paaske

AU - Andersen, Grethe

AU - Simonsen, Claus Ziegler

N1 - © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2024/3/28

Y1 - 2024/3/28

N2 - OBJECTIVES: An increased risk of stroke has been reported among patients with COVID-19 caused by SARS-CoV-2. We aimed to investigate the nationwide prevalence of SARS-CoV-2 among patients with acute ischaemic stroke and to study the impact on stroke severity, quality of care and mortality on an individual patient level.DESIGN: This was a nationwide register-based cohort study.SETTING: We used data from several Danish registers which were linked at an individual patient level using the unique civil registration number assigned to all Danish citizens. Patients were identified from the Danish Stroke Registry and information on SARS-CoV-2 infection status was collected from the Danish National COVID-19 Registry. Concurrent SARS-CoV-2 infection was defined as a positive PCR test within 31 days prior to, and 1 day after, stroke admission. Information on comorbidity was collected from the Danish National Patient Registry and information on vital status was collected from the Danish Civil Registration System.PARTICIPANTS: A total of 11 502 patients admitted with acute ischaemic stroke from 10 March 2020 to 31 May 2021 were included in the study.RESULTS: Among the included patients, the majority (84.6%) were tested for SARS-CoV-2, but only 68 had a positive test. These patients were more prone to have atrial fibrillation and were more often treated with reperfusion therapy. They had a significantly increased risk of severe stroke (adjusted relative risk (aRR) 1.93, 95% CI: 1.22 to 3.04) and a significantly increased 30-day mortality risk (aRR 2.29, 95% CI: 1.19 to 4.39). There was no difference in the proportion of patients fulfilling relevant performance measures on quality of care.CONCLUSION: In this nationwide study, only 0.6% of patients with acute ischaemic stroke were tested positive for a concurrent SARS-CoV-2 infection. The patients with SARS-CoV-2 presented with more severe strokes.

AB - OBJECTIVES: An increased risk of stroke has been reported among patients with COVID-19 caused by SARS-CoV-2. We aimed to investigate the nationwide prevalence of SARS-CoV-2 among patients with acute ischaemic stroke and to study the impact on stroke severity, quality of care and mortality on an individual patient level.DESIGN: This was a nationwide register-based cohort study.SETTING: We used data from several Danish registers which were linked at an individual patient level using the unique civil registration number assigned to all Danish citizens. Patients were identified from the Danish Stroke Registry and information on SARS-CoV-2 infection status was collected from the Danish National COVID-19 Registry. Concurrent SARS-CoV-2 infection was defined as a positive PCR test within 31 days prior to, and 1 day after, stroke admission. Information on comorbidity was collected from the Danish National Patient Registry and information on vital status was collected from the Danish Civil Registration System.PARTICIPANTS: A total of 11 502 patients admitted with acute ischaemic stroke from 10 March 2020 to 31 May 2021 were included in the study.RESULTS: Among the included patients, the majority (84.6%) were tested for SARS-CoV-2, but only 68 had a positive test. These patients were more prone to have atrial fibrillation and were more often treated with reperfusion therapy. They had a significantly increased risk of severe stroke (adjusted relative risk (aRR) 1.93, 95% CI: 1.22 to 3.04) and a significantly increased 30-day mortality risk (aRR 2.29, 95% CI: 1.19 to 4.39). There was no difference in the proportion of patients fulfilling relevant performance measures on quality of care.CONCLUSION: In this nationwide study, only 0.6% of patients with acute ischaemic stroke were tested positive for a concurrent SARS-CoV-2 infection. The patients with SARS-CoV-2 presented with more severe strokes.

KW - Humans

KW - COVID-19

KW - SARS-CoV-2

KW - Cohort Studies

KW - Brain Ischemia/complications

KW - Prevalence

KW - Stroke/epidemiology

KW - Ischemic Stroke/epidemiology

KW - Denmark/epidemiology

U2 - 10.1136/bmjopen-2023-081527

DO - 10.1136/bmjopen-2023-081527

M3 - Journal article

C2 - 38548354

SN - 2044-6055

VL - 14

JO - BMJ Open

JF - BMJ Open

IS - 3

M1 - e081527

ER -

Prevalence and impact of SARS-CoV-2 infection among patients with acute ischaemic stroke: a nationwide register-based cohort study in Denmark

Abstract

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