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

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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.


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.

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