Institute of Biomedical Research of Salamanca, Department of Neurology, Hospital Universitario de Salamanca, Salamanca, Spain.
Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
BMC Neurol. 2021 Jan 30;21(1):43. doi: 10.1186/s12883-021-02075-1.
Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology.
We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20-6/16/20).
Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35-3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p = 0.01) were also independently predictive of mortality.
Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.
COVID-19 与小但具有临床意义的中风风险相关，其病因常常是隐源性的。在一项大型多国连续 COVID-19 中风患者队列研究中，我们根据中风病因评估了隐源性中风的临床预测因素、短期功能结局和住院死亡率。
我们从 4 个国家的 31 家医院连续评估了年龄在 18 岁或以上、急性缺血性中风（AIS）和实验室确诊 COVID-19 的患者，探讨了这些患者的临床特征和短期结局。
在 14483 例实验室确诊 COVID-19 患者中，有 156 例（1.1%）诊断为 AIS。61 例（39.4%）为女性，84 例（67.2%）为白人，88 例（61.5%）年龄在 60-79 岁之间。AIS 最常见的病因是隐源性（55/129，42.6%），与非隐源性 AIS 患者相比，白细胞计数、C 反应蛋白和 D-二聚体水平显著升高（所有比较 p</=0.05）。在一个多变量逐步向后回归模型中，估计住院死亡率的优势比，隐源性中风机制与任何其他机制引起的中风相比，住院死亡率高出五倍（调整后的 OR 5.16，95%CI 1.41-18.87，p=0.01）。在该模型中，年龄较大（每十年增加 2.05，95%CI 1.35-3.11，p<0.01）和较高的基线 NIHSS（aOR 1.12，95%CI 1.02-1.21，p=0.01）也是死亡率的独立预测因素。
我们的研究结果表明，COVID-19 患者的隐源性中风具有早期死亡的高风险。
