Impact of the COVID-19 Pandemic on the Prognosis and Emergency Treatment of Patients with Ischemic Stroke in Suzhou, China: A Multicenter Retrospective Study.

Abstract

Introduction: The COVID-19 pandemic has disrupted stroke care globally. This study aimed to assess the impact of COVID-19 on the clinical characteristics, acute treatment, and outcomes of patients with acute ischemic stroke (AIS) in Suzhou, China.

Methods: This study retrospectively analyzed 506 hospitalized AIS patients from four stroke centers between December 10, 2022, and January 20, 2023. Patients were grouped by COVID- 19 infection status and timing. Clinical data and outcomes were compared with a pre-pandemic cohort from the SUMMITS-II Study.

Results: Among included AIS patients, 54.3% were COVID-19-positive. Infected patients had higher baseline NIHSS scores, elevated inflammatory markers, and more in-hospital complications. Intravenous thrombolysis rates increased slightly during the pandemic, despite longer prehospital delays. Emotional disorders were more frequent post-stroke. COVID-19 infection, particularly concurrent with stroke onset, was linked to worse outcomes at 90 days and 1 year.

Discussion: The findings suggest that the COVID-19 pandemic significantly influenced the clinical characteristics and outcomes of patients with acute ischemic stroke in Suzhou. Patients with AIS with concomitant COVID-19 infection presented with a higher prevalence of vascular risk factors and elevated inflammatory and coagulation markers. Moreover, COVID-19 infection occurring within one week of stroke onset was associated with more severe neurological deficits and poorer short- and long-term prognosis, highlighting the potential role of COVID-19 in worsening stroke outcomes.

Conclusion: The COVID-19 pandemic adversely affected stroke severity and prognosis. While in-hospital workflows were preserved, delayed presentation and increased systemic burden contributed to unfavorable stroke outcomes. Strengthening stroke care delivery and psychological support during public health crises is essential.