Siegler James E, Cardona Pere, Arenillas Juan F, Talavera Blanca, Guillen Ana N, Chavarría-Miranda Alba, de Lera Mercedes, Khandelwal Priyank, Bach Ivo, Patel Pratit, Singla Amit, Requena Manuel, Ribo Marc, Jillella Dinesh V, Rangaraju Srikant, Nogueira Raul G, Haussen Diogo C, Vazquez Alejandro R, Urra Xabier, Chamorro Ángel, Román Luis S, Thon Jesse M, Then Ryna, Sanborn Emma, de la Ossa Natalia P, Millàn Mònica, Ruiz Isaac N, Mansour Ossama Y, Megahed Mohammed, Tiu Cristina, Terecoasa Elena O, Radu Răzvan A, Nguyen Thanh N, Curiale Gioacchino, Kaliaev Artem, Czap Alexandra L, Sebaugh Jacob, Zha Alicia M, Liebeskind David S, Ortega-Gutierrez Santiago, Farooqui Mudassir, Hassan Ameer E, Preston Laurie, Patterson Mary S, Bushnaq Saif, Zaidat Osama, Jovin Tudor G
Cooper Neurologic Institute, Cooper University Hospital, Camden, NJ, USA.
Cooper Medical School of Rowan University, Camden NJ, USA.
Int J Stroke. 2021 Jun;16(4):437-447. doi: 10.1177/1747493020959216. Epub 2020 Sep 30.
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients.
To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease.
Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020-16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST).
Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130-280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19.
COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）与重症患者发生血栓事件的重大风险相关。
总结一个关于感染SARS-CoV-2且患有脑血管疾病患者的多国观察性队列研究的结果。
对四个国家31家医院急诊科评估的或因2019冠状病毒病（COVID-19）入院的连续成年患者进行回顾性观察队列研究（2020年2月1日至2020年6月16日）。主要结局是脑血管事件的发生率，包括急性缺血性卒中、颅内出血（ICH）以及皮质静脉和/或静脉窦血栓形成（CVST）。
在14483例实验室确诊感染SARS-CoV-2的患者中，172例被诊断为急性脑血管事件（占队列的1.13%；每100000例患者中有1130例，95%置信区间为970 - 1320/100000），171例中有68例（40.5%）为女性，172例中有96例（55.8%）年龄在60至79岁之间。其中，156例为急性缺血性卒中（1.08%；每100000例中有1080例，95%置信区间为920 - 1260/100000），28例为ICH（0.19%；每100000例中有190例，95%置信区间为130 - 280/100000），3例为CVST（0.02%；每100000例中有20例，95%置信区间为4 - 60/100000）。SARS-CoV-2相关卒中的院内死亡率为38.1%，ICH为58.3%。在对地点和年龄的聚类、基线卒中严重程度以及单因素回归中发现的所有院内死亡预测因素（p < 0.1：男性、吸烟、通过紧急医疗服务入院、较低的血小板和淋巴细胞计数以及颅内闭塞）进行校正后，隐源性卒中机制（调整后比值比5.01，95%置信区间1.63 - 15.44，p < 0.01）、高龄（调整后比值比1.78，95%置信区间1.07 - 2.94，p = 0.03）以及入院时较低的淋巴细胞计数（调整后比值比0.58，95%置信区间0.34 - 0.98，p = 0.04）是卒中合并COVID-19患者中仅有的独立死亡预测因素。
COVID-19与具有临床意义的脑血管事件存在小但显著的风险相关，尤其是缺血性卒中。COVID-19相关脑血管并发症的死亡率很高；因此，应积极监测并进行早期干预以改善不良结局。
