Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke
George Ntaios
(1)
,
Patrik Michel
(2)
,
Georgios Georgiopoulos
(3)
,
Yutao Guo
(4)
,
Wencheng Li
(5)
,
Jing Xiong
(5)
,
Patricia Calleja
(6, 7)
,
Fernando Ostos
(6, 7)
,
Guillermo González-Ortega
(6, 7)
,
Blanca Fuentes
(8, 9)
,
María Alonso de Leciñana
(8, 9)
,
Exuperio Díez-Tejedor
(8, 9)
,
Sebastian García-Madrona
(10, 11)
,
Jaime Masjuan
(10, 11)
,
Alicia Defelipe
(10, 11)
,
Guillaume Turc
(12, 13)
,
Bruno Goncalves
(12, 13, 14)
,
Valerie Domigo
(12, 13)
,
Gheorghe-Andrei Dan
(15, 16)
,
Roxana Vezeteu
(15, 16)
,
Hanne Christensen
(17)
,
Louisa Marguerite Christensen
(17)
,
Per Meden
(17)
,
Lejla Hajdarevic
(17)
,
Angela Rodriguez-Lopez
(18)
,
Fernando Díaz-Otero
(18)
,
Andrés García-Pastor
(18)
,
Antonio Gil-Nuñez
(18)
,
Errikos Maslias
(2)
,
Davide Strambo
(2)
,
David J Werring
(19)
,
Arvind Chandratheva
(19)
,
Laura Benjamin
(19)
,
Robert Simister
(19)
,
Richard Perry
(19)
,
Rahma Beyrouti
(19)
,
Pascal Jabbour
(20)
,
Ahmad Sweid
(20)
,
Stavropoula Tjoumakaris
(20)
,
Elisa Cuadrado-Godia
(21, 22, 23)
,
Ana Rodríguez Campello
(21, 22, 23)
,
Jaume Roquer
(21, 22, 23)
,
Tiago Moreira
(24)
,
Michael V Mazya
(24)
,
Fabio Bandini
(25)
,
Karl Matz
(26)
,
Helle K Iversen
(27)
,
Alejandra González-Duarte
(28)
,
Cristina Tiu
(16, 29)
,
Julia Ferrari
(30)
,
Milan R Vosko
(30)
,
Helmut J.F. Salzer
(30)
,
Bernd Lamprecht
(30)
,
Martin W Dünser
(31)
,
Carlo W Cereda
(32)
,
Ángel Basilio Corredor Quintero
(33)
,
Eleni Korompoki
(34)
,
Eduardo Soriano-Navarro
(35)
,
Luis Enrique Soto-Ramírez
(35)
,
Paulo F Castañeda-Méndez
(35)
,
Daniela Bay-Sansores
(35)
,
Antonio Arauz
(36)
,
Vanessa Cano-Nigenda
(36)
,
Espen Saxhaug Kristoffersen
(37, 38)
,
Marjaana Tiainen
(39)
,
Daniel Strbian
(39)
,
Jukka Putaala
(39)
,
Gregory Y.H. Lip
(40, 41, 42)
1
University of Thessaly [Larissa]
2 UNIL - Université de Lausanne = University of Lausanne
3 King‘s College London
4 Chinese PLA General Hospital
5 HUST - Huazhong University of Science and Technology [Wuhan]
6 Instituto de Investigación Hospital Universitario 12 de Octubre
7 Doce de Octubre University Hospital
8 La Paz University Hospital
9 IdiPAZ Health Research Institute
10 Ramon & Cajal University Hospital
11 IRYCIS Health Research Institute
12 GHU Paris Psychiatrie et Neurosciences
13 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
14 Paulo Niemeyer State Brain Institute
15 Colentina University Hospital
16 UMPCD - University of Medicine and Pharmacy “Carol Davila” Bucharest
17 BUH - Bispebjerg University Hospital
18 Hospital General Universitario "Gregorio Marañón" [Madrid]
19 UCL Institute of Neurology, Queen Square [London]
20 Thomas Jefferson University Hospitals
21 IMIM-Hospital del Mar
22 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
23 UPF - Universitat Pompeu Fabra [Barcelona]
24 Karolinska Institutet [Stockholm]
25 San Paolo Hospital [Savona]
26 Donau-Universität Krems
27 UCPH - University of Copenhagen = Københavns Universitet
28 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán - National Institute of Medical Science and Nutrition Salvador Zubiran [Mexico]
29 University Emergency Hospital [Bucharest]
30 Kepler University Hospital
31 JKU - University of Linz - Johannes Kepler Universität Linz
32 Stroke Center EOC, Neurocenter of Southern Switzerland
33 Hospital Departamental Universitario del Quindío San Juan de DiosArmenia
34 NKUA - National and Kapodistrian University of Athens
35 Fundación Clínica Médica Sur [Mexico City]
36 Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez [Mexico]
37 Akershus University Hospital [Lørenskog]
38 UiO - University of Oslo
39 HUS - Helsinki University Hospital [Finland]
40 University of Liverpool
41 Liverpool Heart & Chest Hospital
42 AAU - Aalborg University [Denmark]
2 UNIL - Université de Lausanne = University of Lausanne
3 King‘s College London
4 Chinese PLA General Hospital
5 HUST - Huazhong University of Science and Technology [Wuhan]
6 Instituto de Investigación Hospital Universitario 12 de Octubre
7 Doce de Octubre University Hospital
8 La Paz University Hospital
9 IdiPAZ Health Research Institute
10 Ramon & Cajal University Hospital
11 IRYCIS Health Research Institute
12 GHU Paris Psychiatrie et Neurosciences
13 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
14 Paulo Niemeyer State Brain Institute
15 Colentina University Hospital
16 UMPCD - University of Medicine and Pharmacy “Carol Davila” Bucharest
17 BUH - Bispebjerg University Hospital
18 Hospital General Universitario "Gregorio Marañón" [Madrid]
19 UCL Institute of Neurology, Queen Square [London]
20 Thomas Jefferson University Hospitals
21 IMIM-Hospital del Mar
22 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
23 UPF - Universitat Pompeu Fabra [Barcelona]
24 Karolinska Institutet [Stockholm]
25 San Paolo Hospital [Savona]
26 Donau-Universität Krems
27 UCPH - University of Copenhagen = Københavns Universitet
28 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán - National Institute of Medical Science and Nutrition Salvador Zubiran [Mexico]
29 University Emergency Hospital [Bucharest]
30 Kepler University Hospital
31 JKU - University of Linz - Johannes Kepler Universität Linz
32 Stroke Center EOC, Neurocenter of Southern Switzerland
33 Hospital Departamental Universitario del Quindío San Juan de DiosArmenia
34 NKUA - National and Kapodistrian University of Athens
35 Fundación Clínica Médica Sur [Mexico City]
36 Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez [Mexico]
37 Akershus University Hospital [Lørenskog]
38 UiO - University of Oslo
39 HUS - Helsinki University Hospital [Finland]
40 University of Liverpool
41 Liverpool Heart & Chest Hospital
42 AAU - Aalborg University [Denmark]
Alicia Defelipe
- Fonction : Auteur
Guillaume Turc
- Fonction : Auteur
- PersonId : 776614
- ORCID : 0000-0001-5059-4095
- IdRef : 098880470
Bruno Goncalves
- Fonction : Auteur
- PersonId : 1663
- IdHAL : bgoncalves
- ORCID : 0000-0001-5644-3749
Gregory Y.H. Lip
- Fonction : Auteur
- PersonId : 794237
- ORCID : 0000-0002-7566-1626
- IdRef : 075748649
Résumé
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.