Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry-Reference-Cited by-同舟云学术

Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry

Published:2020-09-30 Issue:4 Volume:16 Page:437-447
ISSN:1747-4930
Container-title:International Journal of Stroke
language:en
Short-container-title:International Journal of Stroke

Author:

Siegler James E¹²^ORCID,Cardona Pere³,Arenillas Juan F⁴⁵^ORCID,Talavera Blanca³,Guillen Ana N³,Chavarría-Miranda Alba³^ORCID,de Lera Mercedes³,Khandelwal Priyank⁵,Bach Ivo⁶,Patel Pratit⁵,Singla Amit⁷,Requena Manuel⁸⁹^ORCID,Ribo Marc⁸⁹,Jillella Dinesh V¹⁰,Rangaraju Srikant¹⁰,Nogueira Raul G¹⁰¹¹,Haussen Diogo C¹⁰¹¹,Vazquez Alejandro R¹²,Urra Xabier¹²¹³,Chamorro Ángel¹²¹³^ORCID,Román Luis S¹⁴,Thon Jesse M¹²,Then Ryna¹²,Sanborn Emma¹²,de la Ossa Natalia P¹⁵^ORCID,Millàn Mònica¹⁵,Ruiz Isaac N¹⁵,Mansour Ossama Y¹⁶^ORCID,Megahed Mohammed¹⁷,Tiu Cristina¹⁸¹⁹,Terecoasa Elena O¹⁸¹⁹,Radu Răzvan A¹⁸,Nguyen Thanh N²⁰²¹²²,Curiale Gioacchino²⁰,Kaliaev Artem²¹,Czap Alexandra L²³,Sebaugh Jacob²³,Zha Alicia M²³,Liebeskind David S²⁴,Ortega-Gutierrez Santiago²⁵,Farooqui Mudassir²⁵^ORCID,Hassan Ameer E²⁶²⁷,Preston Laurie²⁶,Patterson Mary S²⁸,Bushnaq Saif²⁸,Zaidat Osama²⁸,Jovin Tudor G¹²

Affiliation:

1. Cooper Neurologic Institute, Cooper University Hospital, Camden, NJ, USA

2. Cooper Medical School of Rowan University, Camden NJ, USA

3. Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, Spain

4. Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain

5. Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid, Consejo Superior de Investigaciones Científicas, Madrid, Spain

6. Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

7. New Jersey Medical School, Newark, NJ, USA

8. Department of Neurosurgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

9. Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain

10. Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain

11. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA

12. Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USA

13. Department of Neurology, Hospital Clínic, Barcelona, Spain

14. Area of Neuroscience, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain

15. Department of Radiology, Hospital Clínic, Barcelona, Spain

16. Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, Badalona, Barcelona, Spain

17. Department of Neurology, Stroke and Neurointervention division, Alexandria University, Alexandria, Egypt

18. Department of Critical Care Medicine, Alexandria University, Alexandria, Egypt

19. Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania

20. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

21. Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA, USA

22. Department of Radiology, Boston Medical Center, Boston University School of Medicine, MA, USA

23. Department of Neurosurgery, Boston Medical Center, Boston University School of Medicine, MA, USA

24. Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA

25. Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

26. Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

27. Department of Clinical Neuroscience Research, Valley Baptist Medical Center, Harlingen, TX, USA

28. Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX, USA

Abstract

Background Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aim To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020–16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970–1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920–1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130–280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4–60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63–15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07–2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34–0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

Publisher

SAGE Publications

Subject

Neurology

Link

http://journals.sagepub.com/doi/pdf/10.1177/1747493020959216

Reference20 articles.

1. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis

2. Incidence of thrombotic complications in critically ill ICU patients with COVID-19

3. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

4. Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19

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

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