Covid-19 Associated High Mortality Among Patients With Acute Stroke In A University Hospital In Kumasi, Ghana – A Retrospective Study

Abstract

Objectives: The World Stroke Organization (WSO) has raised concerns about the global impact of COVID-19 on occurrence of stroke and its implications for stroke care, especially in low-middle-income countries. We sought to describe the profile and outcomes of acute stroke admissions in relation to COVID-19 status.

Methodology: This is a retrospective study involving all stroke patients admitted to the University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana from 1^st March, 2020 to 30^th November, 2020. Stroke was diagnosed clinically and confirmed with a head Computerized Tomography scan. After the diagnosis of stroke, all patients with presentations that fitted the case definition of COVID-19 were tested using real time polymerase chain reaction (RT-PCR). Bivariate analysis was performed to identify factors associated with in-patient mortality. Statistical significance level was set at p < 0.05.

Results: A total of 93 patients with confirmed acute stroke were hospitalized within a 9-month period with 3 (3.2%) having confirmed COVID-19 infection. All COVID-19 cases had ischemic stroke and all of them died. Bivariate analyses identified COVID-19 status (p=0.016), mean pulse rate (p=0.036) and patients who did not receive angiotensin receptor blocker (ARB) (p=0.029) or calcium channel blockers (CCB) (p=0.016) were associated with in-patient mortality.

Conclusion: COVID-19 occurring with acute stroke is a predictor of mortality in this sample of Ghanaians. In this era of COVID-19 pandemic, patients with acute stroke should also be screened for the infection and managed appropriately to minimize death.