Stroke
. 2020 Jul 9;STROKEAHA120031208.
doi: 10.1161/STROKEAHA.120.031208. Online ahead of print.
Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry
George Ntaios 1 , Patrik Michel 2 , Georgios Georgiopoulos 3 , Yutao Guo 4 , Wencheng Li 5 , Jing Xiong 6 , Patricia Calleja 7 , Fernando Ostos 7 , Guillermo Gonz?lez-Ortega 7 , Blanca Fuentes 8 , Mar?a Alonso de Leci?ana 8 , Exuperio D?ez-Tejedor 8 , Sebastian Garc?a-Madrona 9 , Jaime Masjuan 9 , Alicia DeFelipe 9 , Guillaume Turc 10 , Bruno Gon?alves 10 11 , Valerie Domigo 10 , Gheorghe-Andrei Dan 12 , Roxana Vezeteu 12 , Hanne Christensen 13 , Louisa Marguerite Christensen 13 , Per Meden 13 , Lejla Hajdarevic 13 , Angela Rodriguez-Lopez 14 , Fernando D?az-Otero 14 , Andr?s Garc?a-Pastor 14 , Antonio Gil-Nu?ez 14 , Errikos Maslias 2 , Davide Strambo 2 , David J Werring 15 , Arvind Chandratheva 15 , Laura Benjamin 15 , Robert Simister 15 , Richard Perry 15 , Rahma Beyrouti 15 , Pascal Jabbour 16 , Ahmad Sweid 16 , Stavropoula Tjoumakaris 16 , Elisa Cuadrado-Godia 17 18 , Ana Rodr?guez Campello 17 18 , Jaume Roquer 17 18 , Tiago Moreira 19 20 , Michael V Mazya 19 20 , Fabio Bandini 21 , Karl Matz 22 , Helle K Iversen 23 , Alejandra Gonz?lez-Duarte 24 , Cristina Tiu 25 26 , Julia Ferrari 27 , Milan R Vosko 28 , Helmut J F Salzer 29 , Bernd Lamprecht 29 , Martin W D?nser 30 , Carlo W Cereda 31 , ?ngel Basilio Corredor Quintero 32 , Eleni Korompoki 33 , Eduardo Soriano-Navarro 34 , Luis Enrique Soto-Ram?rez 34 , Paulo F Casta?eda-M?ndez 34 , Daniela Bay-Sansores 34 , Antonio Arauz 35 , Vanessa Cano-Nigenda 35 , Espen Saxhaug Kristoffersen 36 37 , Marjaana Tiainen 38 , Daniel Strbian 38 , Jukka Putaala 38 , Gregory Y H Lip 39 40
Affiliations
- PMID: 32787707
- DOI: 10.1161/STROKEAHA.120.031208
Abstract
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 Institute 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 Institute 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 Institute 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.
Keywords: COVID-19; coronavirus; prognosis; propensity score; survivors.