Risk, clinical course, and outcome of ischemic stroke in patients hospitalized with COVID-19: A multicenter cohort study

Wouter M. Sluis, Marijke Linschoten, the CAPACITY-COVID Collaborative Consortium, Julie E. Buijs, J. Matthijs Biesbroek, Heleen M. den Hertog, Tessa Ribbers, Dennis J. Nieuwkamp, Reinier C. van Houwelingen, Andreas Dias, Ingeborg W.M. van Uden, Joost P. Kerklaan, H. Paul Bienfait, Sarah E. Vermeer, Sonja W. de Jong, Mariam Ali, Marieke J.H. Wermer, Marieke T. de Graaf, Paul J.A.M. Brouwers, Folkert W. AsselbergsL. Jaap Kappelle, H. Bart van der Worp, Annemijn M. Algra*, Robert G. Tieleman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)


BACKGROUND AND PURPOSE: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19. METHODS: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke. RESULTS: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52–2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13–2.15]) than patients without stroke. CONCLUSIONS: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.

Original languageEnglish
Pages (from-to)3978-3986
Number of pages9
Issue number12
Publication statusPublished - 1 Dec 2021


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