Patients with stroke and COVID-19 have more severe strokes and higher mortality

A multicenter study, led by neurologists at the Research Instituto of the Sant Pau Hospital and with the participation of the main Catalan hospitals, analyses the relationship between stroke and COVID.


It is known that 57% of patients with COVID-19 experience some neurological manifestation and also that the risk of mortality and morbidity from COVID-19 is increased in those patients who have vascular risk factors. However, to date, there have been no studies on the relationship between COVID-19 and stroke in terms of vital and functional prognosis. On the other hand, if there is indeed a relationship and the prognosis is worse, it should be differentiated whether this is due to the viral infection itself or to pandemic interference in the outpatient and inpatient care systems.

A team of researchers led by Dr. Joan Martí Fàbregas, chief clinician of the Neurology Service of the Hospital de Sant Pau and head of the research group on cerebrovascular diseases at the Research Institute of the Hospital de Sant Pau - IIB Sant Pau, has just published a study on the prognostic relationship between stroke and COVID-19. This is a multicenter study in which neurologists from most hospitals in Catalonia have participated and which could be carried out during the peak of the pandemic from March to May 2020. The study, published in the December issue of the prestigious journal Stroke, collects data from 701 ischemic stroke patients, 91 of whom had COVID-19 infection.

"We found that strokes with concomitant COVID-19 infection were more severe than those without COVID-19 infection. Likewise, the mortality of the group of patients with stroke and COVID-19 is three times that of the mortality in the patients without COVID-19”, explains Dr. Martí Fàbregas. "Despite the worst prognosis we see in patients with stroke and COVID-19, our study also concludes that if the patient overcomes COVID-19 infection, the likelihood of having a good functional prognosis, that is, being independent for the basic activities of daily living such as personal hygiene, eating or dressing, is the same as that of patients without COVID-19”, adds Martí Fàbregas. "On the other hand, although the pandemic compromised the care of patients with stroke due to hospital collapse, this study showed that the poor prognosis is due to the virus infection itself, not to logistical difficulties." he concludes.

This work is the first to address the prognostic relationship between ischemic stroke and COVID-19 and is a first step in understanding the extent to which the pathophysiology of stroke in patients with COVID-19 is different from patients without COVID-19 infection. Future studies will allow to translate this into specific treatment proposals for each type of patient or into recommendations to improve the response of health systems in pandemic situations.


One of the strengths of the study is the amount and consistency of the data that have been included. The collaboration of many hospitals at critical times allowed access to a large amount of data and rigorous information on stroke patients in 19 Catalan hospitals. The study, led by Sant Pau, has had the collaboration of Bellvitge Hospital, Vall d’Hebron Hospital, Germans Trias i Pujol Hospital, Clínic Hospital, Joan XXIII Hospital, Moisès Broggi Hospital, Dr. Josep Trueta, Hospital Arnau de Vilanova, Hospital del Mar, Hospital comarcal de l'Alt Penedès, Hospital Parc Taulí, Hospital de Mataró, Hospital Mútua de Terrassa, Hospital de Tortosa Verge de la Cinta, Hospital General de Granollers, Hospital d'Igualada , Hospital de Figueres, the Terrassa Health Consortium and the Catalan Health Quality and Assessment Agency.

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