Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.).
Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Switzerland (P.M., E.M., D. Strambo).
Stroke. 2020 Sep;51(9):e254-e258. doi: 10.1161/STROKEAHA.120.031208. Epub 2020 Jul 9.
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]), =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], <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.
最近的小样本病例系列表明，2019 年冠状病毒病（COVID-19）与严重大血管急性缺血性中风之间存在病理生理学关联。鉴于严重中风通常与预后不良有关，并且可以通过再通技术非常有效地治疗，因此迫切需要在大型代表性患者队列中确认这种假定的关联，以提醒中风临床医生，并为中风患者的预住院和住院期间提供信息。我们汇集了来自 16 个国家的 28 个地点的所有连续住院的经实验室确诊的 COVID-19 和急性缺血性中风患者。为了评估 COVID-19 患者和非 COVID-19 患者的急性缺血性中风的中风严重程度和结局（在出院时或对仍住院的患者进行的最新评估时进行评估）是否不同，我们对 COVID-19 患者进行了 1：1 倾向评分匹配分析。非 COVID-19 患者来自 2003 年至 2019 年期间在急性中风登记处和洛桑登记处登记的患者。2020 年 1 月 27 日至 2020 年 5 月 19 日，共住院 174 名（中位年龄 71.2 岁；女性 37.9%）患有 COVID-19 和急性缺血性中风的患者（每个地点中位数为 12 名患者）。美国国立卫生研究院中风量表的中位数为 10（四分位距[IQR]，4-18）。在 COVID-19 和非 COVID-19 的 336 名患者的 1：1 匹配样本中，COVID-19 患者的美国国立卫生研究院中风量表中位数更高（10 [IQR，4-18]与 6 [IQR，3-14]），=0.03；（优势比，1.69 [95%CI，1.08-2.65]为更高的美国国立卫生研究院中风量表评分）。有 48 人（27.6%）死亡，其中 22 人归因于 COVID-19，26 人归因于中风。在 96 名有残疾状况信息的幸存者中，49 人（51%）出院时残疾严重。在倾向评分匹配人群（n=330）中，COVID-19 患者发生严重残疾的风险更高（中位数 mRS 4 [IQR，2-6]与 2 [IQR，1-4]，<0.001）和死亡（优势比，4.3 [95%CI，2.22-8.30]）与无 COVID-19 患者相比。我们的研究结果表明，与非 COVID-19 缺血性中风相比，COVID-19 相关的缺血性中风更严重，功能结局更差，死亡率更高。
