Comprehensive assessment of pain syndrome and other clinical factors in the development of adverse outcomes in patients with stroke and concomitant COVID-19

Background. The contribution of both traditional and less typical factors, particularly pain syndrome, to the course of ischemic stroke on the background of coronavirus disease 2019 (COVID-19) remains insufficiently studied, especially in the context of fatal outcomes. Purpose: to evaluate the role of pain syndrome among risk factors for adverse outcomes in ischemic stroke associated with COVID-19. Materials and methods. A retrospective analysis of 85 cases of ischemic stroke with confirmed COVID-19 (2020–2021) was conducted. The mean age of patients was 69.8 ± 12.4 years; the mean National Institutes of Health Stroke Scale (NIHSS) score was 11.2 ± 4.9 points. Musculoskeletal pain, headache, and shoulder pain were assessed. Statistical analysis was performed using IBM SPSS Statistics 22. Results. Pain symptoms were identified in 71.8 % of patients. Pain frequency was significantly higher among those who died: 85.4 vs. 54.1 % in survivors (p = 0.002). A combination of several types of pain was observed in 64.5 % of deceased patients compared to 21.6 % of survivors (p = 0.001). Musculoskeletal pain was more common in lethal cases (68.8 vs. 24.3 %, p = 0.001). A combination of severe stroke (NIHSS > 7) and mo­derate-to-severe or severe COVID-19 was associated with a higher risk of death. In contrast, infection seve-rity did not significantly influence outcomes in mild stroke cases (p = 0.061). Mild COVID-19 was not associated with increased mortality regardless of stroke severity. Hypertension and atrial fibrillation had no significant effect, whereas type 2 diabetes mellitus increased mortality. Conclusions. COVID-19 is a strong modifier of poor stroke outcomes in the acute phase. The absolute risk of death is associated with older age, type 2 diabetes, smoking, pain syndrome, particularly combined one, and musculoskeletal pain playing a prominent role. Moderate-to-severe or severe COVID-19 negatively influences treatment outcomes even in patients with mild stroke.