Rameez Fnu, McCarthy Philip, Cheng Yao, Packard Laurel M, Davis Alan T, Wees Nabil, Khan Nadeem, Singer Justin, Khan Muhib, Min Jiangyong
Department of Neurosciences and Comprehensive Stroke Center, Spectrum Health and Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA.
Spectrum Health Office of Research and Education, Grand Rapids, Michigan, USA.
Cerebrovasc Dis Extra. 2020;10(3):159-165. doi: 10.1159/000512742. Epub 2020 Nov 9.
Our study aims to evaluate the impact of a stay-at-home order on stroke metrics during the 2019-novel coronavirus (COVID-19) pandemic.
Data on baseline characteristics, stroke subtype, initial National Institutes of Health Stroke Scale (NIHSS) score, the time between last known well (LKW) to emergency department (ED) arrival, tissue plasminogen activator (tPA) administration, the involvement of large vessel occlusion (LVO), and whether mechanical thrombectomy (MT) was pursued in patients with acute stroke were extracted from 24 March to 23 April 2020 (the time period of a stay-at-home order was placed due to the COVID-19 pandemic as the study group) at a tertiary care hospital in West Michigan, USA, compared with data from 24 March to 23 April 2019 (control group).
Our study demonstrated a reduction in cases of acute ischemic stroke (AIS), although this did not reach statistical significance. However, there was an increase in hemorrhagic stroke (7.5% controls vs. 19.2% study group). The age of stroke patients was significantly younger during the period of the stay-at-home order compared to the control group. We identified a significant overall delay of ED arrivals from LKW in the study group. Additionally, an increased number of AIS patients with LVO in the study group (34.8%) was found compared to the control group (17.5%). A significantly increased number of patients received MT in the study group. Additionally, 11 patients were COVID-19 PCR-positive in the study group, 10 with AIS and only 1 with hemorrhagic stroke. Patients with COVID-19 had a high incidence of atrial fibrillation and hyperlipidemia. One AIS patient with COVID-19 rapidly developed cytotoxic edema with corresponding elevated inflammatory biomarkers. No statistical significance was noted when stroke subtype, LVO, and MT groups were compared.
There was a trend of decreasing AIS admissions during the COVID-19 pandemic. There was also a significantly increased number of AIS patients with LVO who received MT, especially those with COVID-19. We conclude that cytokine storm resulting from SARS-CoV-2 infection might play a role in AIS patients with COVID-19.
我们的研究旨在评估在2019年新型冠状病毒（COVID-19）大流行期间居家令对卒中指标的影响。
从美国密歇根州西部一家三级护理医院提取2020年3月24日至4月23日（因COVID-19大流行实施居家令的时间段作为研究组）急性卒中患者的基线特征、卒中亚型、初始美国国立卫生研究院卒中量表（NIHSS）评分、最后已知健康状态（LKW）至急诊科（ED）就诊时间、组织型纤溶酶原激活剂（tPA）使用情况、大血管闭塞（LVO）情况以及是否进行了机械取栓（MT）等数据，并与2019年3月24日至4月23日的数据（对照组）进行比较。
我们的研究显示急性缺血性卒中（AIS）病例有所减少，尽管未达到统计学显著性。然而，出血性卒中有所增加（对照组为7.5%，研究组为19.2%）。与对照组相比，居家令期间卒中患者的年龄显著更年轻。我们发现研究组从LKW到ED就诊存在显著的总体延迟。此外，研究组中LVO的AIS患者数量（34.8%）高于对照组（17.5%）。研究组接受MT的患者数量显著增加。此外，研究组中有11例患者COVID-19 PCR检测呈阳性，其中10例为AIS，仅1例为出血性卒中。COVID-19患者房颤和高脂血症的发生率较高。1例患有COVID-19的AIS患者迅速出现细胞毒性水肿，炎症生物标志物相应升高。比较卒中亚型、LVO和MT组时未发现统计学显著性。
在COVID-19大流行期间AIS入院人数有减少趋势。接受MT的LVO的AIS患者数量也显著增加，尤其是患有COVID-19的患者。我们得出结论，SARS-CoV-2感染导致的细胞因子风暴可能在患有COVID-19 的AIS患者中起作用。
