Acute ischaemic stroke associated with SARS-CoV-2 infection in North America
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Published:2022-01-25
Issue:4
Volume:93
Page:360-368
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ISSN:0022-3050
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Container-title:Journal of Neurology, Neurosurgery & Psychiatry
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language:en
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Short-container-title:J Neurol Neurosurg Psychiatry
Author:
Dmytriw Adam AORCID, Dibas Mahmoud, Phan Kevin, Efendizade Aslan, Ospel Johanna, Schirmer Clemens, Settecase Fabio, Heran Manraj K S, Kühn Anna Luisa, Puri Ajit S, Menon Bijoy K, Sivakumar Sanjeev, Mowla Askan, Vela-Duarte Daniel, Linfante Italo, Dabus Guilherme C, Regenhardt Robert W, D'Amato Salvatore, Rosenthal Joseph A, Zha Alicia, Talukder Nafee, Sheth Sunil A, Hassan Ameer EORCID, Cooke Daniel L, Leung Lester Y, Malek Adel MORCID, Voetsch Barbara, Sehgal Siddharth, Wakhloo Ajay K, Goyal Mayank, Wu Hannah, Cohen Jake, Ghozy SheriefORCID, Turkel-Parella David, Farooq Zerwa, Vranic Justin EORCID, Rabinov James D, Stapleton Christopher J, Minhas Ramandeep, Velayudhan Vinodkumar, Chaudhry Zeshan Ahmed, Xavier Andrew, Bullrich Maria Bres, Pandey Sachin, Sposato Luciano A, Johnson Stephen A, Gupta GauravORCID, Khandelwal Priyank, Ali Latisha, Liebeskind David S, Farooqui MudassirORCID, Ortega-Gutierrez Santiago, Nahab Fadi, Jillella Dinesh V, Chen Karen, Aziz-Sultan Mohammad Ali, Abdalkader Mohamad, Kaliaev Artem, Nguyen Thanh NORCID, Haussen Diogo C, Nogueira Raul G, Haq Israr Ul, Zaidat Osama OORCID, Sanborn Emma, Leslie-Mazwi Thabele MORCID, Patel Aman B, Siegler James E, Tiwari AmboojORCID
Abstract
BackgroundTo analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome.MethodsMulticentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications.ResultsA total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, p<0.001), diabetes mellitus (aOR: 2.66, 95% CI 1.16 to 6.09, p=0.021), higher NIHSS at admission (aOR: 1.08, 95% CI 1.02 to 1.14, p=0.006), LVO (aOR: 2.45, 95% CI 1.04 to 5.78, p=0.042), and higher NLR level (aOR: 1.06, 95% CI 1.01 to 1.11, p=0.028) were significantly associated with poor functional outcome.ConclusionThere is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.
Subject
Psychiatry and Mental health,Neurology (clinical),Surgery
Cited by
21 articles.
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