tetano
Editor, Senior Moderator
Stroke
. 2021 Nov 4;STROKEAHA121034787.
doi: 10.1161/STROKEAHA.121.034787. Online ahead of print.
Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort Study
Wouter M Sluis[SUP] 1 [/SUP], Marijke Linschoten[SUP] 2 [/SUP], Julie E Buijs[SUP] 3 [/SUP], J Matthijs Biesbroek[SUP] 4 [/SUP], Heleen M den Hertog[SUP] 5 [/SUP], Tessa Ribbers[SUP] 6 [/SUP], Dennis J Nieuwkamp[SUP] 6 [/SUP], Reinier C van Houwelingen[SUP] 7 [/SUP], Andreas Dias[SUP] 8 [/SUP], Ingeborg W M van Uden[SUP] 9 [/SUP], Joost P Kerklaan[SUP] 10 [/SUP], H Paul Bienfait[SUP] 11 [/SUP], Sarah E Vermeer[SUP] 12 [/SUP], Sonja W de Jong[SUP] 13 [/SUP], Mariam Ali[SUP] 14 [/SUP], Marieke J H Wermer[SUP] 15 [/SUP], Marieke T de Graaf[SUP] 16 [/SUP], Paul J A M Brouwers[SUP] 17 [/SUP], Folkert W Asselbergs[SUP] 2 18 19 [/SUP], L Jaap Kappelle[SUP] 1 [/SUP], H Bart van der Worp[SUP] 1 [/SUP], Annemijn M Algra[SUP] 1 [/SUP], CAPACITY-COVID Collaborative Consortium
Collaborators, Affiliations
Abstract
Background and purpose: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19.
Methods: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke.
Results: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke.
Conclusions: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.
Keywords: COVID-19; hospital mortality; incidence; intensive care units; patient discharge; pulmonary embolism.
. 2021 Nov 4;STROKEAHA121034787.
doi: 10.1161/STROKEAHA.121.034787. Online ahead of print.
Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort Study
Wouter M Sluis[SUP] 1 [/SUP], Marijke Linschoten[SUP] 2 [/SUP], Julie E Buijs[SUP] 3 [/SUP], J Matthijs Biesbroek[SUP] 4 [/SUP], Heleen M den Hertog[SUP] 5 [/SUP], Tessa Ribbers[SUP] 6 [/SUP], Dennis J Nieuwkamp[SUP] 6 [/SUP], Reinier C van Houwelingen[SUP] 7 [/SUP], Andreas Dias[SUP] 8 [/SUP], Ingeborg W M van Uden[SUP] 9 [/SUP], Joost P Kerklaan[SUP] 10 [/SUP], H Paul Bienfait[SUP] 11 [/SUP], Sarah E Vermeer[SUP] 12 [/SUP], Sonja W de Jong[SUP] 13 [/SUP], Mariam Ali[SUP] 14 [/SUP], Marieke J H Wermer[SUP] 15 [/SUP], Marieke T de Graaf[SUP] 16 [/SUP], Paul J A M Brouwers[SUP] 17 [/SUP], Folkert W Asselbergs[SUP] 2 18 19 [/SUP], L Jaap Kappelle[SUP] 1 [/SUP], H Bart van der Worp[SUP] 1 [/SUP], Annemijn M Algra[SUP] 1 [/SUP], CAPACITY-COVID Collaborative Consortium
Collaborators, Affiliations
- PMID: 34732073
- DOI: 10.1161/STROKEAHA.121.034787
Abstract
Background and purpose: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19.
Methods: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke.
Results: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke.
Conclusions: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.
Keywords: COVID-19; hospital mortality; incidence; intensive care units; patient discharge; pulmonary embolism.