TY - JOUR
T1 - Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke
T2 - The Global COVID-19 Stroke Registry
AU - Ntaios, George
AU - Michel, Patrik
AU - Georgiopoulos, Georgios
AU - Guo, Yutao
AU - Li, Wencheng
AU - Xiong, Jing
AU - Calleja, Patricia
AU - Ostos, Fernando
AU - González-Ortega, Guillermo
AU - Fuentes, Blanca
AU - Alonso de Leciñana, María
AU - Díez-Tejedor, Exuperio
AU - García-Madrona, Sebastian
AU - Masjuan, Jaime
AU - DeFelipe, Alicia
AU - Turc, Guillaume
AU - Gonçalves, Bruno
AU - Domigo, Valerie
AU - Dan, Gheorghe-Andrei
AU - Vezeteu, Roxana
AU - Christensen, Hanne
AU - Christensen, Louisa Marguerite
AU - Meden, Per
AU - Hajdarevic, Lejla
AU - Rodriguez-Lopez, Angela
AU - Díaz-Otero, Fernando
AU - García-Pastor, Andrés
AU - Gil-Nuñez, Antonio
AU - Maslias, Errikos
AU - Strambo, Davide
AU - Werring, David J
AU - Chandratheva, Arvind
AU - Benjamin, Laura
AU - Simister, Robert
AU - Perry, Richard
AU - Beyrouti, Rahma
AU - Jabbour, Pascal
AU - Sweid, Ahmad
AU - Tjoumakaris, Stavropoula
AU - Cuadrado-Godia, Elisa
AU - Campello, Ana Rodríguez
AU - Roquer, Jaume
AU - Moreira, Tiago
AU - Mazya, Michael V
AU - Bandini, Fabio
AU - Matz, Karl
AU - Iversen, Helle K
AU - González-Duarte, Alejandra
AU - Tiu, Cristina
AU - Ferrari, Julia
AU - Vosko, Milan R
AU - Salzer, Helmut J F
AU - Lamprecht, Bernd
AU - Dünser, Martin W
AU - Cereda, Carlo W
AU - Quintero, Ángel Basilio Corredor
AU - Korompoki, Eleni
AU - Soriano-Navarro, Eduardo
AU - Soto-Ramírez, Luis Enrique
AU - Castañeda-Méndez, Paulo F
AU - Bay-Sansores, Daniela
AU - Arauz, Antonio
AU - Cano-Nigenda, Vanessa
AU - Kristoffersen, Espen Saxhaug
AU - Tiainen, Marjaana
AU - Strbian, Daniel
AU - Putaala, Jukka
AU - Lip, Gregory Y H
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - Aged
KW - Aged, 80 and over
KW - Brain Ischemia/complications
KW - COVID-19
KW - Cohort Studies
KW - Coronavirus Infections/complications
KW - Disability Evaluation
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Pandemics
KW - Pneumonia, Viral/complications
KW - Propensity Score
KW - Recovery of Function
KW - Registries
KW - Stroke/complications
KW - Survival Analysis
KW - Time-to-Treatment
KW - Tomography, X-Ray Computed
KW - Treatment Outcome
U2 - 10.1161/STROKEAHA.120.031208
DO - 10.1161/STROKEAHA.120.031208
M3 - Journal article
C2 - 32787707
VL - 51
SP - e254-e258
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 9
ER -