Department of Neurology, Icahn School of Medicine at Mount Sinai, New York.
Stroke. 2021 Jan;52(1):48-56. doi: 10.1161/STROKEAHA.120.031668. Epub 2020 Dec 7.
Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known.
We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results.
Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, <0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal (=0.02), parietal (=0.002), occipital (=0.002), and cerebellar (=0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay (<0.0001), greater percentage requiring intensive care unit care (=0.017), and greater rate of neurological worsening during admission (<0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, <0.0001).
Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.
2019 年冠状病毒病（COVID-19）与血栓事件的发生率增加有关，包括中风。然而，COVID-19 合并中风患者的特征和结局尚不清楚。
我们对纽约市一家大型医疗系统中 COVID-19 患者的危险因素、中风特征和短期结局进行了回顾性观察性研究。我们纳入了 2020 年 3 月 1 日至 2020 年 4 月 30 日期间连续入院的急性脑血管事件患者。根据 COVID-19 状态以及人口统计学变量、合并症、中风特征、影像学结果和住院结局进行分层。在 COVID-19 阳性患者中，我们还总结了实验室检查结果。
在 277 名中风患者中，有 105 名（38.0%）COVID-19 阳性。与 COVID-19 阴性患者相比，COVID-19 阳性患者中风的病因更可能是隐源性（51.8%比 22.3%，<0.0001），并且更可能在颞叶（=0.02）、顶叶（=0.002）、枕叶（=0.002）和小脑（=0.028）区域发生缺血性中风。在 COVID-19 阳性患者中，平均凝血标志物略有升高（凝血酶原时间 15.4±3.6 秒，部分凝血活酶时间 38.6±24.5 秒，国际标准化比值 1.4±1.3）。COVID-19 阳性患者的结局更差，包括住院时间延长（<0.0001）、需要入住重症监护病房的比例更高（=0.017）和住院期间神经恶化的发生率更高（<0.0001）；此外，更多 COVID-19 阳性患者发生院内死亡（33%比 12.9%，<0.0001）。
比较 COVID-19 阳性和阴性患者的基线特征相似。然而，COVID-19 阳性患者更有可能出现局灶性脑梗死，更常见的病因是隐源性，结局更差。
