Strambo Davide, De Marchis Gian Marco, Bonati Leo H, Arnold Marcel, Carrera Emmanuel, Galletta Santi, Nedeltchev Krassen, Kahles Timo, Cereda Carlo W, Bianco Giovanni, Kägi Georg, Luft Andreas R, Bolognese Manuel, Lakatos Lehel-Barna, Salmen Stephan, Correia Pamela, Sturzenegger Rolf, Sylvan Albert, Medlin Friedrich, Berger Christian, Lindheimer Florian, Baumgärtner Markus, Schelosky Ludwig, Bonvin Christophe, Mono Marie-Luise, Rodic Biljana, von Reding Andrea, Schwegler Guido, Massini Federico, Tarnutzer Alexander A, Taheri Shadi, Peters Nils, Beyeler Morin, Altersberger Valerian, Engelter Stefan T, Fischer Urs, Michel Patrik
Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
Eur J Neurol. 2022 Mar;29(3):732-743. doi: 10.1111/ene.15199. Epub 2021 Dec 9.
Most case series of patients with ischemic stroke (IS) and COVID-19 are limited to selected centers or lack 3-month outcomes. The aim of this study was to describe the frequency, clinical and radiological features, and 3-month outcomes of patients with IS and COVID-19 in a nationwide stroke registry.
From the Swiss Stroke Registry (SSR), we included all consecutive IS patients ≥18 years admitted to Swiss Stroke Centers or Stroke Units during the first wave of COVID-19 (25 February to 8 June 2020). We compared baseline features, etiology, and 3-month outcome of SARS-CoV-2 polymerase chain reaction-positive (PCR+) IS patients to SARS-CoV-2 PCR- and/or asymptomatic non-tested IS patients.
Of the 2341 IS patients registered in the SSR during the study period, 36 (1.5%) had confirmed COVID-19 infection, of which 33 were within 1 month before or after stroke onset. In multivariate analysis, COVID+ patients had more lesions in multiple vascular territories (OR 2.35, 95% CI 1.08-5.14, p = 0.032) and fewer cryptogenic strokes (OR 0.37, 95% CI 0.14-0.99, p = 0.049). COVID-19 was judged the likely principal cause of stroke in 8 patients (24%), a contributing/triggering factor in 12 (36%), and likely not contributing to stroke in 13 patients (40%). There was a strong trend towards worse functional outcome in COVID+ patients after propensity score (PS) adjustment for age, stroke severity, and revascularization treatments (PS-adjusted common OR for shift towards higher modified Rankin Scale (mRS) = 1.85, 95% CI 0.96-3.58, p = 0.07).
In this nationwide analysis of consecutive ischemic strokes, concomitant COVID-19 was relatively rare. COVID+ patients more often had multi-territory stroke and less often cryptogenic stroke, and their 3-month functional outcome tended to be worse.
大多数关于缺血性卒中（IS）合并新型冠状病毒肺炎（COVID-19）患者的病例系列研究局限于特定中心，或缺乏3个月的预后数据。本研究旨在描述全国性卒中登记中IS合并COVID-19患者的发生率、临床和影像学特征以及3个月的预后情况。
我们从瑞士卒中登记（SSR）中纳入了在COVID-19第一波疫情期间（2020年2月25日至6月8日）入住瑞士卒中中心或卒中单元的所有年龄≥18岁的连续性IS患者。我们将严重急性呼吸综合征冠状病毒2（SARS-CoV-2）聚合酶链反应阳性（PCR+）的IS患者的基线特征、病因和3个月预后与SARS-CoV-2 PCR阴性和/或无症状未检测的IS患者进行了比较。
在研究期间登记在SSR中的2341例IS患者中，36例（1.5%）确诊感染COVID-19，其中33例在卒中发作前或后1个月内。在多变量分析中，COVID+患者在多个血管区域有更多病灶（比值比[OR]2.35，95%置信区间[CI]1.08-5.14，p = 0.032），隐源性卒中较少（OR 0.37，95%CI 0.14-0.99，p = 0.049）。在8例患者（24%）中，COVID-19被判定为卒中的可能主要原因，在12例患者（36%）中为促成/触发因素，在13例患者（40%）中可能与卒中无关。在对年龄、卒中严重程度和血管再通治疗进行倾向评分（PS）调整后，COVID+患者的功能预后有恶化的强烈趋势（PS调整后向更高改良Rankin量表[mRS]转变的共同OR = 1.85，95%CI 0.96-3.58，p = 0.07）。结论：在这项对连续性缺血性卒中的全国性分析中，合并COVID-19相对少见。COVID+患者多为多区域卒中，隐源性卒中较少，其3个月的功能预后往往较差。
