Functional and discharge outcomes of ischemic stroke patients with concurrent COVID-19 infection: a single-center retrospective study

COVID-19 is associated with vascular complications like ischemia due to endothelial injury, hypercoagulability, and inflammation. Data regarding early functional recovery, discharge destination, and health-system outcomes remain limited. This study examines the association between COVID-19 and discharge-level functional outcomes among ischemic stroke patients. Adult ischemic stroke patients admitted to our Joint Commission-certified stroke center, were retrospectively analyzed (3/1/2020-3/1/2022). Functional status at discharge (FSD), length of stay, discharge destination, and neurologic complications were compared between COVID-positive(C+) and COVID-negative(C-) patients. A subgroup analysis was conducted upon vaccination availability (4/14/2021-3/1/2022). Multivariable logistic regression identified predictors of mortality. Of 1,171 stroke patients in the study period, 41 (3.5%) tested positive for COVID-19. The days between stroke and death did not reach statistical significance in C- and C+ patients (C+:4 vs. C-:25 days, p = 0.103). C+ patients had higher modified Rankin Scale (mRS) scores at discharge (3 vs. 1, p = 0.001) and higher rates of altered consciousness (41.46% vs. 21.86%, p = 0.03). After the vaccine was introduced, C+ patients had less days from stroke to death (4 vs. 42 days, p = 0.047), worse mRS scores (3 vs. 1, p = 0.009), longer delays in discharge placement (0 vs. 1 day, p = 0.020), and higher rates of altered consciousness (57.89% vs. 23.71%, p = 0.001). C- patients were more often discharged home (49.52% vs. 36.84%, p = 0.021). Higher admission National Institute of Health Stroke Scale (OR: 1.028[1.003–1.053], p = 0.027), older age (OR: 1.027[1.011–1.045], p = 0.001), and pre-existing diabetes (OR: 1.596[1.056–2.413], p = 0.027) increased mortality risks. COVID-19 infection among ischemic stroke patients is associated with worse recovery outcomes and discharge delays compared to COVID-negative patients. These findings highlight the impact of COVID-19 infection on inpatient recovery and discharge planning. Not applicable.