Acute ischaemic stroke associated with SARS-CoV-2 infection in North America. Issue 4 (25th January 2022)

• Record Type: Journal Article
• Authors: Dmytriw, Adam A; Dibas, Mahmoud; Phan, Kevin; Efendizade, Aslan; Ospel, Johanna; Schirmer, Clemens; Settecase, Fabio; Heran, Manraj K S; Kühn, Anna Luisa; Puri, Ajit S; Menon, Bijoy K; Sivakumar, Sanjeev; Mowla, Askan; Vela-Duarte, Daniel; Linfante, Italo; Dabus, Guilherme C; Regenhardt, Robert W; D'Amato, Salvatore; Rosenthal, Joseph A; Zha, Alicia; Talukder, Nafee; Sheth, Sunil A; Hassan, Ameer E; Cooke, Daniel L; Leung, Lester Y; Malek, Adel M; Voetsch, Barbara; Sehgal, Siddharth; Wakhloo, Ajay K; Goyal, Mayank; Wu, Hannah; Cohen, Jake; Ghozy, Sherief; Turkel-Parella, David; Farooq, Zerwa; Vranic, Justin E; Rabinov, James D; Stapleton, Christopher J; Minhas, Ramandeep; Velayudhan, Vinodkumar; Chaudhry, Zeshan Ahmed; Xavier, Andrew; Bullrich, Maria Bres; Pandey, Sachin; Sposato, Luciano A; Johnson, Stephen A; Gupta, Gaurav; Khandelwal, Priyank; Ali, Latisha; Liebeskind, David S; Farooqui, Mudassir; Ortega-Gutierrez, Santiago; Nahab, Fadi; Jillella, Dinesh V; Chen, Karen; Aziz-Sultan, Mohammad Ali; Abdalkader, Mohamad; Kaliaev, Artem; Nguyen, Thanh N; Haussen, Diogo C; Nogueira, Raul G; Haq, Israr Ul; Zaidat, Osama O; Sanborn, Emma; Leslie-Mazwi, Thabele M; Patel, Aman B; Siegler, James E; Tiwari, Ambooj;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 93:Issue 4(2022)
• Page Start: 360
• Page End: 368
• Publication Date: 2022-01-25
• Subjects: COVID-19 -- stroke -- interventional; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2021-328354
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome. Methods: Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications. Results: A total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, p<0.001), diabetes mellitus (aOR: 2.66, 95% CI 1.16 to 6.09, p=0.021), higher NIHSS at admission (aOR: 1.08, 95% CI 1.02 to 1.14, p=0.006), LVO (aOR: 2.45, 95% CI 1.04 to 5.78, p=0.042), and higher NLR level (aOR: 1.06, 95% CI 1.01 to 1.11, p=0.028) were significantly associated with poor functional outcome. Conclusion: There is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.