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Response by Kummer et al to Letter Regarding Article, "History of Stroke Is Independently Associated With In-Hospital Death in Patients With COVID-19".

In Response: We would like to thank Cao et al1 for their interest in our study. We agree that it is important to consider the severity of respiratory disease when characterizing the relationship between the history of stroke and mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). To this point, we conducted a sensitivity analysis wherein our original multivariable logistic regression model was adjusted for the presence of oxygen saturation below 90% on admission. In this newly adjusted analysis, a history of stroke remained significantly associated with in-hospital mortality (adjusted odds ratio, 1.51 [95% CI, 1.17–1.96]). We nonetheless agree with Cao et al’s1 astute observations that these findings require further confirmation through analyses that incorporate larger patient cohorts and adjust for several additional factors that are associated with mortality in COVID-19. These include laboratory markers such as ferritin, serum interleukins, blood cell counts and D-dimer levels,2,3 in addition to clinical factors such as intubation status and presence of comorbid acute stroke. Additionally, it is important to take into consideration the timeframe of our study when interpreting its results. The period between March and May of 2020 spanned the peak of the first COVID-19 pandemic wave in New York City,4 which may explain the high rates of COVID-19 infection and in-hospital mortality that we found in our analysis, and may have affected the generalizability of our results. These facts lend further support to the idea that our findings should be further investigated in additional studies that include periods with both high and low community transmission of COVID-19.