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 -