Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry.
Adult
Aged
Aged, 80 and over
Brain Ischemia
COVID-19
/ blood
Cohort Studies
Computed Tomography Angiography
Egypt
/ epidemiology
Female
Fibrin Fibrinogen Degradation Products
/ metabolism
Hospital Mortality
Humans
Ischemic Stroke
/ blood
Magnetic Resonance Imaging
Male
Middle Aged
Registries
Retrospective Studies
Risk Factors
SARS-CoV-2
Spain
/ epidemiology
Stroke
United States
/ epidemiology
COVID-19
Coronavirus
Cryptogenic
Mortality
Stroke
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
30 Jan 2021
30 Jan 2021
Historique:
received:
18
11
2020
accepted:
19
01
2021
entrez:
30
1
2021
pubmed:
31
1
2021
medline:
7
2
2021
Statut:
epublish
Résumé
Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20-6/16/20). Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35-3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p = 0.01) were also independently predictive of mortality. Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology.
METHODS
METHODS
We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20-6/16/20).
RESULTS
RESULTS
Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35-3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p = 0.01) were also independently predictive of mortality.
CONCLUSIONS
CONCLUSIONS
Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.
Identifiants
pubmed: 33514335
doi: 10.1186/s12883-021-02075-1
pii: 10.1186/s12883-021-02075-1
pmc: PMC7846488
doi:
Substances chimiques
Fibrin Fibrinogen Degradation Products
0
fibrin fragment D
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
43Investigateurs
Patricia Feineigle
(P)
Mohamad Abdalkader
(M)
Sergio Amaro
(S)
Hugo Aparicio
(H)
Ivo Bach
(I)
Jordi Blasco
(J)
Ángel Chamorro
(Á)
Judith Clark
(J)
Alexandra Czap
(A)
Natalia Perez de la Ossa
(NP)
Shashvat Desai
(S)
Laura Dorado
(L)
Denise Evans
(D)
Mudassir Farooqui
(M)
Meritxell Gomis
(M)
Mark Heslin
(M)
Chris Higham
(C)
Ashutosh P Jadhav
(AP)
Tudor G Jovin
(TG)
Artem Kaliaev
(A)
Priyank Khandelwal
(P)
Rakeshh Khatri
(R)
Amy Krueger
(A)
Carlos Laredo
(C)
Italo Linfante
(I)
Antonio López
(A)
Racheal McCoy
(R)
Mònica Millàn
(M)
Mahmoud H Mohammaden
(MH)
Leigh Moore
(L)
Isaac Nuño Ruiz
(IN)
Víctor Obach
(V)
Darko Quispe Orozco
(DQ)
Santiago Ortega-Gutierrez
(S)
Pratit Patel
(P)
Mary S Patterson
(MS)
Gonzalo Valle Peñacoba
(GV)
Leonardo Pisani
(L)
Laurie Preston
(L)
Razvan Alexandru Radu
(RA)
Vivek Rai
(V)
Anna Ramos-Pachón
(A)
Ankit Rana
(A)
Srikant Rangaraju
(S)
Jose Rafael Romero
(JR)
Salvatore Rudilosso
(S)
Emma Sanborn
(E)
Sunil Sheth
(S)
Julie G Shulman
(JG)
Amit Singla
(A)
Ainsley Smith
(A)
Amy Starosciak
(A)
Lauren Thau
(L)
Ephrem Teklemariam
(E)
Elena Oana Terecoasa
(EO)
Cristina Tiu
(C)
Vlad Eugen Tiu
(VE)
Israr Ul Haq
(IU)
Martha Vargas
(M)
Víctor Vera
(V)
Osama Zaidat
(O)
Cynthia Zevallos
(C)
Alicia M Zha
(AM)
Références
Front Neurol. 2020 Aug 20;11:910
pubmed: 32973666
Brain. 2020 Oct 1;143(10):3104-3120
pubmed: 32637987
J Neurol Neurosurg Psychiatry. 2020 Aug;91(8):889-891
pubmed: 32354768
Stroke. 2020 Sep;51(9):2656-2663
pubmed: 32755349
Stroke. 2020 Jul;51(7):2002-2011
pubmed: 32432996
Neurology. 2020 Aug 25;95(8):e1060-e1070
pubmed: 32482845
Lancet Infect Dis. 2020 May;20(5):533-534
pubmed: 32087114
Stroke. 1988 May;19(5):604-7
pubmed: 3363593
Stroke. 2020 Sep;51(9):e254-e258
pubmed: 32787707
Intensive Care Med. 2020 Aug;46(8):1603-1606
pubmed: 32415314
Brain. 2020 Oct 1;143(10):3089-3103
pubmed: 32645151
Cerebrovasc Dis. 2020;49(4):451-458
pubmed: 32690850
Int J Stroke. 2021 Jun;16(4):437-447
pubmed: 32852257
Scott Med J. 1957 May;2(5):200-15
pubmed: 13432835
J Biomed Inform. 2019 Jul;95:103208
pubmed: 31078660
Stroke. 2020 Sep;51(9):e219-e222
pubmed: 32684145
JAMA Neurol. 2020 Aug 1;77(8):1018-1027
pubmed: 32469387
Stroke. 1993 Jan;24(1):35-41
pubmed: 7678184
Lancet Neurol. 2020 Sep;19(9):767-783
pubmed: 32622375
JAMA Neurol. 2020 Jun 1;77(6):683-690
pubmed: 32275288
Clin Neurol Neurosurg. 2021 Feb;201:106436
pubmed: 33383463
Ann Neurol. 2021 Feb;89(2):380-388
pubmed: 33219563
Int J Stroke. 2020 Oct;15(7):733-742
pubmed: 32501751