Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Griffith University School of Medicine, Gold Coast, QLD, Australia.
Crit Care Med. 2021 Dec 1;49(12):e1223-e1233. doi: 10.1097/CCM.0000000000005209.
Stroke has been reported in observational series as a frequent complication of coronavirus disease 2019, but more information is needed regarding stroke prevalence and outcomes. We explored the prevalence and outcomes of acute stroke in an international cohort of patients with coronavirus disease 2019 who required ICU admission.
Retrospective analysis of prospectively collected database.
A registry of coronavirus disease 2019 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with acute stroke during their stay.
Patients older than 18 years old with acute coronavirus disease 2019 infection in ICU.
None.
Of 2,699 patients identified (median age 59 yr; male 65%), 59 (2.2%) experienced acute stroke: 0.7% ischemic, 1.0% hemorrhagic, and 0.5% unspecified type. Systemic anticoagulant use was not associated with any stroke type. The frequency of diabetes, hypertension, and smoking was higher in patients with ischemic stroke than in stroke-free and hemorrhagic stroke patients. Extracorporeal membrane oxygenation support was more common among patients with hemorrhagic (56%) and ischemic stroke (16%) than in those without stroke (10%). Extracorporeal membrane oxygenation patients had higher cumulative 90-day probabilities of hemorrhagic (relative risk = 10.5) and ischemic stroke (relative risk = 1.7) versus nonextracorporeal membrane oxygenation patients. Hemorrhagic stroke increased the hazard of death (hazard ratio = 2.74), but ischemic stroke did not-similar to the effects of these stroke types seen in noncoronavirus disease 2019 ICU patients.
In an international registry of ICU patients with coronavirus disease 2019, stroke was infrequent. Hemorrhagic stroke, but not ischemic stroke, was associated with increased mortality. Further, both hemorrhagic stroke and ischemic stroke were associated with traditional vascular risk factors. Extracorporeal membrane oxygenation use was strongly associated with both stroke and death.
已有观察性研究系列报道称，新冠肺炎患者常出现脑卒中并发症，但脑卒中的发病率和结局仍需更多信息。本研究旨在探讨国际新冠肺炎重症监护病房（ICU）患者队列中急性脑卒中的发病率和结局。
前瞻性数据库的回顾性分析。
在超过 370 个国际站点的新冠肺炎 ICU 患者登记处，对入住期间确诊急性脑卒中的患者进行了回顾性分析。
入住 ICU 的 18 岁以上新冠肺炎急性感染患者。
无。
共纳入 2699 例患者（中位年龄 59 岁，男性占 65%），59 例（2.2%）发生急性脑卒中：缺血性脑卒中占 0.7%，出血性脑卒中占 1.0%，未分类脑卒中占 0.5%。全身抗凝治疗与任何类型脑卒中均无关。与非脑卒中患者相比，缺血性脑卒中患者的糖尿病、高血压和吸烟史更为常见。与非脑卒中患者相比，出血性脑卒中（56%）和缺血性脑卒中（16%）患者更常接受体外膜肺氧合（ECMO）支持。与非 ECMO 患者相比，接受 ECMO 治疗的患者 90 天内发生出血性脑卒中（相对风险比=10.5）和缺血性脑卒中（相对风险比=1.7）的累积概率更高。出血性脑卒中增加了死亡风险（风险比=2.74），但缺血性脑卒中未增加（与非新冠肺炎 ICU 患者中这些脑卒中类型的影响相似）。
在国际新冠肺炎 ICU 患者登记处，脑卒中发病率较低。出血性脑卒中而非缺血性脑卒中与死亡率增加相关。此外，出血性脑卒中与缺血性脑卒中均与传统血管危险因素相关。ECMO 的使用与脑卒中及死亡均密切相关。
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