Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke-Reference-Cited by-同舟云学术

Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke

Published:2020-09 Issue:9 Volume:51 Page:
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Ntaios George¹^ORCID,Michel Patrik²,Georgiopoulos Georgios³,Guo Yutao⁴,Li Wencheng⁵,Xiong Jing⁶,Calleja Patricia⁷,Ostos Fernando⁷,González-Ortega Guillermo⁷,Fuentes Blanca⁸,Alonso de Leciñana María⁸,Díez-Tejedor Exuperio⁸,García-Madrona Sebastian⁹,Masjuan Jaime⁹,DeFelipe Alicia⁹,Turc Guillaume¹⁰,Gonçalves Bruno¹⁰¹¹,Domigo Valerie¹⁰,Dan Gheorghe-Andrei¹²,Vezeteu Roxana¹²,Christensen Hanne¹³,Christensen Louisa Marguerite¹³,Meden Per¹³,Hajdarevic Lejla¹³,Rodriguez-Lopez Angela¹⁴,Díaz-Otero Fernando¹⁴,García-Pastor Andrés¹⁴,Gil-Nuñez Antonio¹⁴,Maslias Errikos²,Strambo Davide²,Werring David J.¹⁵,Chandratheva Arvind¹⁵,Benjamin Laura¹⁵,Simister Robert¹⁵,Perry Richard¹⁵,Beyrouti Rahma¹⁵,Jabbour Pascal¹⁶,Sweid Ahmad¹⁶,Tjoumakaris Stavropoula¹⁶,Cuadrado-Godia Elisa¹⁷¹⁸,Campello Ana Rodríguez¹⁷¹⁸,Roquer Jaume¹⁷¹⁸,Moreira Tiago¹⁹²⁰,Mazya Michael V.¹⁹²⁰,Bandini Fabio²¹,Matz Karl²²,Iversen Helle K.²³,González-Duarte Alejandra²⁴,Tiu Cristina²⁵²⁶,Ferrari Julia²⁷,Vosko Milan R.²⁸,Salzer Helmut J.F.²⁹,Lamprecht Bernd²⁹,Dünser Martin W.³⁰,Cereda Carlo W.³¹,Quintero Ángel Basilio Corredor³²,Korompoki Eleni³³,Soriano-Navarro Eduardo³⁴,Soto-Ramírez Luis Enrique³⁴,Castañeda-Méndez Paulo F.³⁴,Bay-Sansores Daniela³⁴,Arauz Antonio³⁵,Cano-Nigenda Vanessa³⁵,Kristoffersen Espen Saxhaug³⁶³⁷,Tiainen Marjaana³⁸,Strbian Daniel³⁸,Putaala Jukka³⁸,Lip Gregory Y.H.³⁹⁴⁰

Affiliation:

1. Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.).

2. Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland (P.M., E.M., D. Strambo).

3. School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom (G.G.).

4. Department of Cardiology, Chinese PLA General Hospital, Beijing, China (Y.G.).

5. Department of Urology (W.L.), Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, China.

6. Department of Nephrology (J.X.), Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, China.

7. Department of Neurology and Stroke Center, Doce de Octubre University Hospital, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (P.C., F.O., G.G.-O.).

8. Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain (B.F., M.A.d.L., E.D.-T.).

9. Department of Neurology and Stroke Centre, Ramón y Cajal University Hospital, IRYCIS Health Research Institute, Madrid, Spain (S.G.-M., J.M., A.D.).

10. Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, and FHU Neurovasc, France (G.T., B.G., V.D.).

11. Intensive Care Unit, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil (B.G.).

12. Colentina University Hospital, Medicine Faculty, University of Medicine “Carol Davila”-Bucharest, Romania (G.-A.D., R.V.).

13. Bispebjerg Hospital & University of Copenhagen, Denmark (H.C., L.M.C., P.M., L.H.).

14. Vascular Neurology Section - Stroke Center, Hospital General Universitario Gregorio Marañón, Madrid, Spain (A.R.L., F.D.O., A.G.P., A.G.-N.).

15. Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W., A.C., L.B., R.S., R.P., R.B.).

16. Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (P.J., A.S., S.T.).

17. Stroke Unit, Department of Neurology, Hospital del Mar (E.C.-G., A.R.C., J.R.).

18. Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d’Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain (E.C.-G., A.R.C., J.R.).

19. Department of Clinical Neuroscience (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden.

20. Department of Neurology (T.M., M.V.M.), Karolinska Institutet, Stockholm, Sweden.

21. Department of Neurology, San Paolo Hospital, Savona, Italy (F.B.).

22. Landesklinikum Mödling, Neurologische Abteilung und Donau-Universität Krems, Zentrum für Vaskuläre Prävention, Krems, Austria (K.M.).

23. Stroke Centre Rigshospitalet, Department of Neurology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (H.K.I.).

24. Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a COVID Center, Mexico City (A.G.-D.).

25. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (C.T.).

26. University Emergency Hospital, Bucharest, Romania (C.T.).

27. Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria (J.F.).

28. Department of Neurology 2 (M.R.V.), Kepler University Hospital, Linz, Austria.

29. Department of Pulmonary Medicine (H.J.F.S., B.L.), Kepler University Hospital, Linz, Austria.

30. Department of Anesthesiology and Intensive Care Medicine, Johannes Kepler University, Linz, Austria (M.W.D.).

31. Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano (C.W.C.).

32. Department of Neurology, Hospital Departamental Universitario del Quindío San Juan de DiosArmenia, Colombia (Á.B.C.Q.).

33. Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Greece (E.K.).

34. Internal Medicine, Fundación Clínica Médica Sur, Mexico City (E.S.-N., L.E.S.-R., P.F.C.-M., D.B.-S.).

35. Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City (A.A., V.C.-N.).

36. Department of Neurology, Akershus University Hospital, Norway (E.S.K.).

37. Department of General Practice, HELSAM, University of Oslo (E.S.K.).

38. Department of Neurology, Helsinki University Hospital, Finland (M.T., D. Strbian, J.P.).

39. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom (G.Y.H.L.).

40. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).

Abstract

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4–18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4–18] versus 6 [IQR, 3–14]), P =0.03; (odds ratio, 1.69 [95% CI, 1.08–2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2–6] versus 2 [IQR, 1–4], P <0.001) and death (odds ratio, 4.3 [95% CI, 2.22–8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Reference8 articles.

1. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

2. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young

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4. SARS-CoV-2 and Stroke in a New York Healthcare System

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