Incidence and risk factors for stroke in patients with COVID-19 in the Philippines: An analysis of 10,881 cases

Roland Dominic G Jamora; Mario B Prado Jr; Veeda Michelle M Anlacan; Marie Charmaine C Sy; Adrian I Espiritu

doi:10.1016/j.jstrokecerebrovasdis.2022.106776

Incidence and risk factors for stroke in patients with COVID-19 in the Philippines: An analysis of 10,881 cases

J Stroke Cerebrovasc Dis. 2022 Nov;31(11):106776. doi: 10.1016/j.jstrokecerebrovasdis.2022.106776. Epub 2022 Sep 8.

Authors

Roland Dominic G Jamora¹, Mario B Prado Jr², Veeda Michelle M Anlacan³, Marie Charmaine C Sy⁴, Adrian I Espiritu⁵

Affiliations

¹ Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Philippines. Electronic address: rgjamora@up.edu.ph.
² Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines.
³ Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Department of Neurology, Institute of Neurological Sciences, The Medical City, Pasig City, Philippines.
⁴ Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
⁵ Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines; Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

PMID: 36113391
PMCID: PMC9452414
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106776

Abstract

Background: While most large studies on the possible association of COVID-19 and stroke were done in high-income countries, only a few studies consisting of small sample populations have been done in low- to middle-income countries like the Philippines.

Objectives: To determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines; to determine the possible association between these risk factors and stroke among the same cohort; and to determine if there is an association between mortality and stroke in this same group.

Methodology: We obtained relevant clinical and neurological, including stroke data from the Philippine CORONA study, an observational study involving 10,881 patients with COVID-19 admitted in 37 referral hospitals from all over the Philippines.

Results: The incidence of stroke among patients with COVID-19 was 3.4% (n = 367). There were more deaths among patients with stroke and COVID-19 than those without stroke and COVID-19 (42.2% vs 14.7%, p < 0.01). In addition, more patients with stroke were admitted in the ICU (43.3% vs 15.0%, p < 0.01) regardless of cause. Smoking (OR: 1.5, 95% CI: 1.3 to 1.7, p < 0.0001), hypertension (OR:1.75, 95% CI:1.53 to 1.97, p < 0.0001), presence of heart failure (OR: 1.4, 95% CI: 1.07 to 1.86, p = 0.01), presence of any neurologic co-morbidities (OR: 1.4, 95% CI:1.11 to 1.46, p = 0.004), and history of stroke (OR:2.3, 95% CI:1.82 to 2.97, p < 0.0001) had direct significant correlation with stroke; while being a health care worker (OR: 0.5, 95% CI: 0.33 to 0.70, p < 0.0004) had an inverse significant association with stroke.

Conclusion: COVID-19 stroke patients in the Philippines have a higher mortality and ICU admission rates than patients with COVID-19 alone or COVID-19 stroke patients from developed countries. Our cohort has similar cardiovascular and metabolic risk factors to western patients with stroke, highlighting that COVID-19 may only have a small contribution to stroke incidence.

Keywords: Acute hemorrhagic stroke; Acute ischemic stroke; COVID-19; Low-to-middle-income countries; Risk factors.

Publication types

Observational Study

MeSH terms

COVID-19*
Humans
Incidence
Philippines / epidemiology
Retrospective Studies
Risk Factors
Stroke* / complications
Stroke* / diagnosis
Stroke* / epidemiology