AUTHOR=Almarghalani Daniyah A. , Almehmadi Khulood A. , Hammad Alaa M. , Alzahrani Mohammad S. , Qadri Marwa , Sindi Joud Amin , Alharthi Rahaf Abdulaziz , Aloudah Maha Nasser , Alghamdi Sarah Abdulrahman , Alsuwat Shahad Jameel , Almutairi Muath B. , Hakami Alqassem Y. , Alamri Faisal F. , Makkawi Seraj 
  
TITLE=Impact of COVID-19 on ischemic stroke patterns and outcomes: a multicenter retrospective study using propensity score matching
  
JOURNAL=Frontiers in Medicine
  
VOLUME=Volume 13 - 2026
  
YEAR=2026
  
URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1750243
  
DOI=10.3389/fmed.2026.1750243
  
ISSN=2296-858X
  
ABSTRACT=BackgroundThe impact of coronavirus disease 2019 (COVID-19) on ischemic stroke outcomes remains uncertain, particularly in multicenter Middle Eastern cohorts. This study aimed to assess stroke-related complications and in-hospital outcomes in patients with and without COVID-19 using a propensity score–matched design.MethodsWe retrospectively analyzed 820 ischemic stroke patients admitted to three tertiary hospitals in Saudi Arabia between March 2020 and March 2021. Among these patients, 711 had no COVID-19, and 109 had confirmed COVID-19. Propensity score matching (2:1) was performed on the basis of age, sex, smoking status, diabetes status, hypertension status, and ischemic heart disease, resulting in a matched cohort of 327 patients (218 non-COVID-19 patients and 109 COVID-19 patients). Clinical outcomes were compared via conditional logistic regression.ResultsAfter matching, COVID-19 patients had significantly longer hospital stays (median 5 vs. 3 days, p = 0.044) and higher rates of pneumonia (54.1% vs. 10.6%, p < 0.001), cognitive impairment (11.9% vs. 2.8%, p = 0.001), and in-hospital mortality (23.9% vs. 10.1%, p = 0.001). COVID-19 infection was significantly associated with pneumonia (OR = 10.88; 95% CI: 5.36–22.08, p < 0.001), cognitive impairment (OR = 5.81; 95% CI: 1.87–18.00, p = 0.002), and in-hospital death (OR = 2.98; 95% CI: 1.53–5.79, p = 0.001).ConclusionCOVID-19 infection independently worsens ischemic stroke outcomes, increasing the risk of pneumonia, cognitive impairment, and in-hospital mortality even after adjustment for baseline factors. These findings highlight the need for intensified respiratory and neurological monitoring and may guide the clinical prioritization of high-risk stroke patients during infectious disease outbreaks.