Vol 55, No 3 (2021)
Research Paper
Published online: 2021-05-05

open access

Page views 1606
Article views/downloads 887
Get Citation

Connect on Social Media

Connect on Social Media

4C Mortality Score correlates with in-hospital functional outcome after COVID-19-associated ischaemic stroke

Katarzyna Sawczyńska12, Marcin Wnuk12, Jeremiasz Jagiełła12, Tomasz Kęsek2, Magdalena Wolska-Sikora3, Magdalena Szara-Cichoń3, Kinga Zagata-Szewczyk4, Adela Uchacz4, Katarzyna Filipowicz4, Marcin Plaszczak4, Katarzyna Spisak-Borowska5, Anna Baranowska6, Magdalena Wójcik-Pędziwiatr7, Marta Swarowska-Skuza7, Elżbieta Szczygieł-Pilut7, Mariusz Kłos8, Piotr Grzyb8, Michał Biela8, Joanna Mierzwińska3, Iwona Sinkiewicz4, Jerzy Machowski5, Anna Węgrzyn6, Michał Michalski7, Ryszard Nowak8, Agnieszka Słowik12
Pubmed: 33949676
Neurol Neurochir Pol 2021;55(3):295-299.

Abstract

Aim of the study. The 4C Mortality Score was created to predict mortality in hospitalised patients with COVID-19 and has to date been evaluated only in respiratory system disorders. The aim of this study was to investigate its application in patients with COVID-19-associated acute ischaemic stroke (AIS).

Clinical rationale for study.
COVID-19 is a risk factor for AIS. COVID-19-associated AIS results in higher mortality and worse functional outcome. Predictors of functional outcome in COVID-19-associated AIS are required.

Materials and methods. This was a retrospective observational study of patients with AIS hospitalised in seven neurological wards in Małopolska Voivodship (Poland) between August and December 2020. We gathered data concerning the patients’ age, sex, presence of cardiovascular risk factors, type of treatment received, and the presence of stroke-associated infections (including pneumonia, urinary tract infection and infection of unknown source). We calculated 4C Mortality Score at stroke onset, and investigated whether there was a correlation with neurological deficit measured using the National Health Institute Stroke Scale (NIHSS) and functional outcome assessed using the modified Rankin Scale (mRS) at discharge.

Results. The study included 52 patients with COVID-19-associated AIS. The 4C Mortality Score at stroke onset correlated with mRS (rs = 0.565, p < 0.01) at discharge. There was also a statistically significant difference in the mean 4C Mortality Score between patients who died and patients who survived the stroke (13.08 ± 2.71 vs. 9.85 ± 3.47, p = 0.04).

Conclusions and clinical implications. 4C Mortality Score predicts functional outcome at discharge in COVID-19-associated AIS patients.

Article available in PDF format

View PDF Download PDF file

References

  1. Moro E, Priori A, Beghi E, et al. EAN core COVID-19 Task Force. The international European Academy of Neurology survey on neurological symptoms in patients with COVID-19 infection. Eur J Neurol. 2020; 27(9): 1727–1737.
  2. Nannoni S, de Groot R, Bell S, et al. Stroke in COVID-19: A systematic review and meta-analysis. Int J Stroke. 2021; 16(2): 137–149.
  3. Siegler JE, Cardona P, Arenillas JF, et al. Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry. Int J Stroke. 2020 [Epub ahead of print]: 1747493020959216.
  4. Fatima N, Saqqur M, Qamar F, et al. Impact of COVID-19 on neurological manifestations: an overview of stroke presentation in pandemic. Neurol Sci. 2020; 41(10): 2675–2679.
  5. Belani P, Schefflein J, Kihira S, et al. COVID-19 Is an Independent Risk Factor for Acute Ischemic Stroke. AJNR Am J Neuroradiol. 2020; 41(8): 1361–1364.
  6. Hess DC, Eldahshan W, Rutkowski E. COVID-19-Related Stroke. Transl Stroke Res. 2020; 11(3): 322–325.
  7. Spence JD, de Freitas GR, Pettigrew LC, et al. Mechanisms of Stroke in COVID-19. Cerebrovasc Dis. 2020; 49(4): 451–458.
  8. Perry RJ, Smith CJ, Roffe C, et al. SETICOS collaborators. Characteristics and outcomes of COVID-19 associated stroke: a UK multicentre case-control study. J Neurol Neurosurg Psychiatry. 2021; 92(3): 242–248.
  9. Ntaios G, Michel P, Georgiopoulos G, et al. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke. 2020; 51(9): e254–e258.
  10. Knight SR, Ho A, et al. Risk stratification of patients admitted to hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: development and validation of the 4C Mortality Score. BMJ. 2020; 371: m4334.
  11. Derbisz J, Nowak K, Wnuk M, et al. Prognostic Significance of Stroke-Associated Infection and other Readily Available Parameters in Acute Ischemic Stroke Treated by Intravenous Thrombolysis. J Stroke Cerebrovasc Dis. 2021; 30(2): 105525.
  12. Wellbelove Z, Walsh C, Perinpanathan T, et al. Comparing the 4C mortality score for COVID-19 to established scores (CURB65, CRB65, qSOFA, NEWS) for respiratory infection patients. J Infect. 2021; 82(3): 414–451.
  13. Vogrig A, Bagatto D, Gigli GL, et al. Causality in COVID-19-associated stroke: a uniform case definition for use in clinical research. J Neurol. 2021; 268(3): 758–761.
  14. Wassie GT, Azene AG, Bantie GM, et al. Incubation Period of Severe Acute Respiratory Syndrome Novel Coronavirus 2 that Causes Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Curr Ther Res Clin Exp. 2020; 93: 100607.



Neurologia i Neurochirurgia Polska