{"doi":"10.1101/2020.05.18.20105494","title":"Risk of Ischemic Stroke in Patients with Covid-19 versus Patients with Influenza","abstract":"IMPORTANCE: Case series without control groups suggest that Covid-19 may cause ischemic stroke, but whether Covid-19 is associated with a higher risk of ischemic stroke than would be expected from a viral respiratory infection is uncertain. OBJECTIVE: To compare the rate of ischemic stroke between patients with Covid-19 and patients with influenza, a respiratory viral illness previously linked to stroke. DESIGN: A retrospective cohort study. SETTING: Two academic hospitals in New York City. PARTICIPANTS: We included adult patients with emergency department visits or hospitalizations with Covid-19 from March 4, 2020 through May 2, 2020. Our comparison cohort included adult patients with emergency department visits or hospitalizations with influenza A or B from January 1, 2016 through May 31, 2018 (calendar years spanning moderate and severe influenza seasons). Exposures: Covid-19 infection confirmed by evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the nasopharynx by polymerase chain reaction, and laboratory-confirmed influenza A or B. Main Outcomes and Measures: A panel of neurologists adjudicated the primary outcome of acute ischemic stroke and its clinical characteristics, etiological mechanisms, and outcomes. We used logistic regression to compare the proportion of Covid-19 patients with ischemic stroke versus the proportion among patients with influenza. RESULTS: Among 2,132 patients with emergency department visits or hospitalizations with Covid-19, 31 patients (1.5%; 95% confidence interval [CI], 1.0%-2.1%) had an acute ischemic stroke. The median age of patients with stroke was 69 years (interquartile range, 66-78) and 58% were men. Stroke was the reason for hospital presentation in 8 (26%) cases. For our comparison cohort, we identified 1,516 patients with influenza, of whom 0.2% (95% CI, 0.0-0.6%) had an acute ischemic stroke. After adjustment for age, sex, and race, the likelihood of stroke was significantly higher with Covid-19 than with influenza infection (odds ratio, 7.5; 95% CI, 2.3-24.9). CONCLUSIONS AND RELEVANCE: Approximately 1.5% of patients with emergency department visits or hospitalizations with Covid-19 experienced ischemic stroke, a rate 7.5-fold higher than in patients with influenza. Future studies should investigate the thrombotic mechanisms in Covid-19 in order to determine optimal strategies to prevent disabling complications like ischemic stroke.","journal":"medRxiv","year":2020,"id":118748,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":43,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9564,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":278961,"name":"Neal S. Parikh","orcid":"0000-0002-8802-2380","position":1,"is_corresponding":false},{"id":278963,"name":"Saad Mir","orcid":"0000-0001-8954-4802","position":2,"is_corresponding":false},{"id":278966,"name":"Ajay Gupta","orcid":"0000-0003-2816-0340","position":3,"is_corresponding":false},{"id":109055,"name":"Hooman Kamel","orcid":"0000-0002-5745-0307","position":4,"is_corresponding":false},{"id":278955,"name":"Eaton Lin","orcid":"0000-0003-1860-4059","position":5,"is_corresponding":false},{"id":278956,"name":"Joshua Lantos","orcid":"0000-0003-4323-7828","position":6,"is_corresponding":false},{"id":364894,"name":"Edward J. Schenck","orcid":"0000-0002-7950-5989","position":7,"is_corresponding":false},{"id":228353,"name":"Parag Goyal","orcid":"0000-0001-7474-3737","position":8,"is_corresponding":false},{"id":551989,"name":"Samuel S. Bruce","orcid":"0000-0002-4502-1572","position":9,"is_corresponding":false},{"id":551990,"name":"Joshua Kahan","orcid":"0000-0002-1443-9837","position":10,"is_corresponding":false},{"id":553112,"name":"Kelsey N. Lansdale","orcid":null,"position":11,"is_corresponding":false},{"id":551991,"name":"Natalie M. LeMoss","orcid":"0000-0002-2379-809X","position":12,"is_corresponding":false},{"id":301019,"name":"Santosh B. Murthy","orcid":"0000-0002-4950-0992","position":13,"is_corresponding":false},{"id":551992,"name":"Philip E. Stieg","orcid":"0000-0002-8414-8277","position":14,"is_corresponding":false},{"id":551993,"name":"Matthew E. Fink","orcid":"0000-0001-6649-3184","position":15,"is_corresponding":false},{"id":108249,"name":"Costantino Iadecola","orcid":"0000-0001-9797-073X","position":16,"is_corresponding":false},{"id":551994,"name":"Alan Z. Segal","orcid":"0000-0001-8703-9108","position":17,"is_corresponding":false},{"id":278959,"name":"Thomas R. Campion","orcid":"0000-0001-7624-769X","position":18,"is_corresponding":false},{"id":305709,"name":"Iván Díaz","orcid":"0000-0001-9056-2047","position":19,"is_corresponding":false},{"id":278964,"name":"Cenai Zhang","orcid":"0000-0001-8137-1644","position":20,"is_corresponding":false},{"id":278960,"name":"Babak B. Navi","orcid":"0000-0001-8424-6128","position":21,"is_corresponding":false},{"id":278962,"name":"Alexander E. Merkler","orcid":"0000-0002-2211-299X","position":0,"is_corresponding":true}],"reference_count":13,"raw_metadata":null,"created_at":"2026-07-18T23:14:03.409507Z","pmid":"32511527","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}