Peng Teng J, Jasne Adam S, Simonov Michael, Abdelhakim Safa, Kone Gbambele, Cheng Yee Kuang, Rethana Melissa, Tarasaria Karan, Herman Alison L, Baker Anna D, Yaghi Shadi, Frontera Jennifer A, Sansing Lauren H, Falcone Guido J, Spudich Serena, Schindler Joseph, Sheth Kevin N, Sharma Richa
Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States.
Front Neurol. 2021 Oct 4;12:741044. doi: 10.3389/fneur.2021.741044. eCollection 2021.
Our objective was to identify characteristics associated with having an acute ischemic stroke (AIS) among hospitalized COVID-19 patients and the subset of these patients with a neurologic symptom. Our derivation cohort consisted of COVID-19 patients admitted to Yale-New Haven Health between January 3, 2020 and August 28, 2020 with and without AIS. We also studied a sub-cohort of hospitalized COVID-19 patients demonstrating a neurologic symptom with and without an AIS. Demographic, clinical, and laboratory results were compared between AIS and non-AIS patients in the full COVID-19 cohort and in the sub-cohort of COVID-19 patients with a neurologic symptom. Multivariable logistic regression models were built to predict ischemic stroke risk in these two COVID-19 cohorts. These 2 models were externally validated in COVID-19 patients hospitalized at a major health system in New York. We then compared the distribution of the resulting predictors in a non-COVID ischemic stroke control cohort. A total of 1,827 patients were included in the derivation cohort (AIS = 44; no AIS = 1,783). Among all hospitalized COVID-19 patients, history of prior stroke and platelet count ≥ 200 × 1,000/μL at hospital presentation were independent predictors of AIS (derivation AUC 0.89, validation AUC 0.82), irrespective of COVID-19 severity. Among hospitalized COVID-19 patients with a neurologic symptom ( = 827), the risk of AIS was significantly higher among patients with a history of prior stroke and age <60 (derivation AUC 0.83, validation AUC 0.81). Notably, in a non-COVID ischemic stroke control cohort ( = 168), AIS patients were significantly older and less likely to have had a prior stroke, demonstrating the uniqueness of AIS patients with COVID-19. Hospitalized COVID-19 patients who demonstrate a neurologic symptom and have either a history of prior stroke or are of younger age are at higher risk of ischemic stroke.
我们的目标是确定住院的新冠肺炎患者中与急性缺血性卒中（AIS）相关的特征，以及这些有神经系统症状的患者亚组的相关特征。我们的推导队列包括2020年1月3日至2020年8月28日期间入住耶鲁-纽黑文医疗系统的新冠肺炎患者，有或无AIS。我们还研究了一组住院的有或无AIS的出现神经系统症状的新冠肺炎患者亚队列。在整个新冠肺炎队列以及有神经系统症状的新冠肺炎患者亚队列中，对AIS患者和非AIS患者的人口统计学、临床和实验室结果进行了比较。构建了多变量逻辑回归模型来预测这两个新冠肺炎队列中的缺血性卒中风险。这两个模型在纽约一家大型医疗系统住院的新冠肺炎患者中进行了外部验证。然后，我们在一个非新冠肺炎缺血性卒中对照队列中比较了所得预测因素的分布。推导队列共纳入1827例患者（AIS = 44例；无AIS = 1783例）。在所有住院的新冠肺炎患者中，既往卒中史和入院时血小板计数≥200×1000/μL是AIS的独立预测因素（推导AUC为0.89，验证AUC为0.82），与新冠肺炎严重程度无关。在有神经系统症状的住院新冠肺炎患者（n = 827）中，既往有卒中史且年龄<60岁的患者发生AIS的风险显著更高（推导AUC为0.83，验证AUC为0.81）。值得注意的是，在一个非新冠肺炎缺血性卒中对照队列（n = 168）中，AIS患者年龄显著更大，既往有卒中史的可能性更小，这表明新冠肺炎AIS患者的独特性。出现神经系统症状且有既往卒中史或年龄较轻的住院新冠肺炎患者发生缺血性卒中的风险更高。
