新型冠状病毒肺炎相关卒中——单中心经验

COVID-19 Associated Stroke-A Single Centre Experience.

作者信息

Sundar Uma, Karnik Niteen D, Mukhopadhyay Amita, Darole Pramod, Kolte Shaonak, Bansal Ashank, Gokhale Yojana A, Asole Dnaneshwar, Joshi Anagha, Pednekar Sangeeta, Chavan Swati, Trivedi Trupti, Padwal Namita, Kalekar Lalana, Londhe Charulata

机构信息

Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra; Corresponding Author.

Professor, Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC&GH), Mumbai, Maharashtra.

出版信息

J Assoc Physicians India. 2021 Jun;69(6):11-12.

PMID:34472782

Abstract

BACKGROUND AND PURPOSE

Various neurological complications have been reported in association with COVID-19. We report our experience of COVID-19 with stroke at a single center over a period of eight months spanning 1 March to 31 October 2020.

METHODS

We recruited all patients admitted to Internal Medicine with an acute stroke, who also tested positive for COVID-19 on RTPCR. We included all stroke cases in our analysis for prediction of in-hospital mortality, and separately analyzed arterial infarcts for vascular territory of ischemic strokes.

RESULTS

There were 62 stroke cases among 3923 COVID-19 admissions (incidence 1.6%). Data was available for 58 patients {mean age 52.6 years; age range 17-91; F/M=20/38; 24% (14/58) aged ≤40; 51% (30/58) hypertensive; 36% (21/58) diabetic; 41% (24/58) with O2 saturation <95% at admission; 32/58 (55.17 %) in-hospital mortality}. Among 58 strokes, there were 44 arterial infarcts, seven bleeds, three arterial infarcts with associated cerebral venous sinus thrombosis, two combined infarct and bleed, and two of indeterminate type. Among the total 49 infarcts, Carotid territory was the commonest affected (36/49; 73.5%), followed by vertebrobasilar (7/49; 14.3%) and both (6/49; 12.2%). Concordant arterial block was seen in 61% (19 of 31 infarcts with angiography done). 'Early stroke' (within 48 hours of respiratory symptoms) was seen in 82.7% (48/58) patients. Patients with poor saturation at admission were older (58 vs 49 years) and had more comorbidities and higher mortality (79% vs 38%). Mortality was similar in young strokes and older patients, although the latter required more intense respiratory support. Logistic regression analysis showed that low Glasgow coma score (GCS) and requirement for increasing intensity of respiratory support predicted in-hospital mortality.

CONCLUSIONS

We had a 1.6% incidence of COVID-19 related stroke of which the majority were carotid territory infarcts. In-hospital mortality was 55.17%, predicted by low GCS at admission.

摘要

背景与目的

已有多种与新型冠状病毒肺炎（COVID-19）相关的神经并发症报道。我们报告了2020年3月1日至10月31日这八个月期间，在单一中心收治的COVID-19合并卒中患者的情况。

方法

我们招募了所有因急性卒中入住内科且经逆转录聚合酶链反应（RTPCR）检测COVID-19呈阳性的患者。我们将所有卒中病例纳入分析以预测住院死亡率，并分别分析动脉梗死在缺血性卒中血管区域的情况。

结果

在3923例COVID-19住院患者中有62例卒中病例（发病率1.6%）。58例患者有可用数据{平均年龄52.6岁；年龄范围17 - 91岁；女性/男性=20/38；24%（14/58）年龄≤40岁；51%（30/58）患有高血压；36%（21/58）患有糖尿病；41%（24/58）入院时血氧饱和度<95%；32/58（55.17%）住院死亡}。58例卒中患者中，有44例动脉梗死、7例出血、3例动脉梗死合并脑静脉窦血栓形成、2例梗死合并出血以及2例类型不确定。在总共49例梗死中，颈动脉区域最常受累（36/49；73.5%），其次是椎基底动脉区域（7/49；14.3%）和两者均受累（6/49；12.2%）。在进行血管造影的31例梗死中有61%（19例）发现动脉阻塞一致。82.7%（48/58）的患者出现“早期卒中”（在呼吸道症状出现后48小时内）。入院时血氧饱和度差的患者年龄更大（58岁对49岁），合并症更多，死亡率更高（79%对38%）。年轻卒中患者和老年患者的死亡率相似，尽管后者需要更加强烈的呼吸支持。逻辑回归分析显示，低格拉斯哥昏迷评分（GCS）和对增加呼吸支持强度的需求可预测住院死亡率。