Work

Impact of COVID-19 on ischemic stroke patterns and outcomes: a multicenter retrospective study using propensity score matching

Year: 2026

Type: article

Abstract: Background The impact of coronavirus disease 2019 (COVID-19) on ischemic stroke outcomes remains uncertain, particularly in multicenter Middle Eastern cohorts. This study aimed to assess stroke-related complications and in-hospital outcomes in patients with and without COVID-19 using a propensity score–matched design. Methods We retrospectively analyzed 820 ischemic stroke patients admitted to three tertiary hospitals in Saudi Arabia between March 2020 and March 2021. Among these patients, 711 had no COVID-19, and 109 had confirmed COVID-19. Propensity score matching (2:1) was performed on the basis of age, sex, smoking status, diabetes status, hypertension status, and ischemic heart disease, resulting in a matched cohort of 327 patients (218 non-COVID-19 patients and 109 COVID-19 patients). Clinical outcomes were compared via conditional logistic regression. Results After matching, COVID-19 patients had significantly longer hospital stays (median 5 vs. 3 days, p = 0.044) and higher rates of pneumonia (54.1% vs. 10.6%, p < 0.001), cognitive impairment (11.9% vs. 2.8%, p = 0.001), and in-hospital mortality (23.9% vs. 10.1%, p = 0.001). COVID-19 infection was significantly associated with pneumonia (OR = 10.88; 95% CI: 5.36–22.08, p < 0.001), cognitive impairment (OR = 5.81; 95% CI: 1.87–18.00, p = 0.002), and in-hospital death (OR = 2.98; 95% CI: 1.53–5.79, p = 0.001). Conclusion COVID-19 infection independently worsens ischemic stroke outcomes, increasing the risk of pneumonia, cognitive impairment, and in-hospital mortality even after adjustment for baseline factors. These findings highlight the need for intensified respiratory and neurological monitoring and may guide the clinical prioritization of high-risk stroke patients during infectious disease outbreaks.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1750243