Incidence and risk factors for stroke in patients with COVID-19 in the Philippines: An analysis of 10,881 cases |
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| Affiliation: | 1. Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines;2. Institute for Neurosciences, St. Luke''s Medical Center, Quezon City and Global City, Philippines;3. Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines;4. Department of Neurology, Institute of Neurological Sciences, The Medical City, Pasig City, Philippines;5. Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines;6. Division of Neurology, Department of Medicine, St. Michael''s Hospital, University of Toronto, Toronto, Ontario, Canada |
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| Abstract: | BackgroundWhile most large studies on the possible association of COVID-19 and stroke were done in high-income countries, only a few studies consisting of small sample populations have been done in low- to middle-income countries like the Philippines.ObjectivesTo determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines; to determine the possible association between these risk factors and stroke among the same cohort; and to determine if there is an association between mortality and stroke in this same group.MethodologyWe obtained relevant clinical and neurological, including stroke data from the Philippine CORONA study, an observational study involving 10,881 patients with COVID-19 admitted in 37 referral hospitals from all over the Philippines.ResultsThe incidence of stroke among patients with COVID-19 was 3.4% (n = 367). There were more deaths among patients with stroke and COVID-19 than those without stroke and COVID-19 (42.2% vs 14.7%, p < 0.01). In addition, more patients with stroke were admitted in the ICU (43.3% vs 15.0%, p < 0.01) regardless of cause. Smoking (OR: 1.5, 95% CI: 1.3 to 1.7, p < 0.0001), hypertension (OR:1.75, 95% CI:1.53 to 1.97, p < 0.0001), presence of heart failure (OR: 1.4, 95% CI: 1.07 to 1.86, p = 0.01), presence of any neurologic co-morbidities (OR: 1.4, 95% CI:1.11 to 1.46, p = 0.004), and history of stroke (OR:2.3, 95% CI:1.82 to 2.97, p < 0.0001) had direct significant correlation with stroke; while being a health care worker (OR: 0.5, 95% CI: 0.33 to 0.70, p < 0.0004) had an inverse significant association with stroke.ConclusionCOVID-19 stroke patients in the Philippines have a higher mortality and ICU admission rates than patients with COVID-19 alone or COVID-19 stroke patients from developed countries. Our cohort has similar cardiovascular and metabolic risk factors to western patients with stroke, highlighting that COVID-19 may only have a small contribution to stroke incidence. |
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