Nishiyama Yasuhiro, Miyamoto Susumu, Sakaguchi Manabu, Sakai Nobuyuki, Yoshida Kensaku, Tokuda Naoki, Ichi Shunsuke, Iguchi Yasuyuki, Koga Masatoshi, Yamaura Ikuya, Hirano Teruyuki, Yamagami Hiroshi, Kimura Kazumi
Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Stroke Support Center, Kyoto University Hospital, Kyoto, Japan.
J Neurol Sci. 2024 Feb 15;457:122865. doi: 10.1016/j.jns.2023.122865. Epub 2024 Jan 4.
We investigated the clinical characteristics and outcomes of stroke in SARS-CoV-2 infected patients in Japan.
This prospective, multicenter observational study of stroke in patients with SARS-CoV-2 infection involving 563 primary stroke centers across Japan was conducted between July 2020, and May 2022. We included 159 stroke cases (131 ischemic stroke, 2 transient ischemic attack (TIA), 21 intracranial hemorrhage, and 5 subarachnoid hemorrhage) and collected their clinical characteristics. Ischemic stroke and TIA (n = 133) were analyzed separately.
The mean age of the 159 patients was 70.6 years, with 66% being men. Poor outcomes (modified Rankin Scale score 5-6) occurred in 40% (63/159) at discharge. Among patients with ischemic stroke and TIA, 30%, 18%, 10%, and 42% had cardioembolism, large-artery atherosclerosis, small-vessel occlusion, and cryptogenic stroke or embolic stroke of undetermined source, respectively. One-third (34%) presented with large vessel occlusion (LVO) of the internal carotid, middle cerebral M1, or basilar arteries. Poor outcomes included age (adjusted odds ratio (aOR): 1.06, 95%CI: 1.01-1.12), ischemic heart disease (IHD) history (aOR: 13.00, 95%CI: 1.51-111.70), moderate to severe pneumonia (aOR: 7.78, 95%CI: 1.18-51.42), an National Institutes of Health Stroke Scale score at baseline (aOR: 1.10, 95%CI: 1.03-1.17), LVO (aOR: 14.88, 95%CI: 2.33-94.97), and log D-dimer (aOR: 3.38, 95%CI: 1.01-11.26).
Upon discharge, 40% of SARS-CoV-2 infected patients with ischemic stroke and TIA had poor outcomes. Poor outcomes were associated with older age, IHD history, moderate to severe pneumonia, higher NIHSS scores, LVO, and higher log D-dimer.
UMIN Clinical Trials Registry: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000041226.
我们调查了日本感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）患者的中风临床特征及预后情况。
这项针对SARS-CoV-2感染患者中风的前瞻性、多中心观察性研究于2020年7月至2022年5月在日本全国563个初级中风中心开展。我们纳入了159例中风病例（131例缺血性中风、2例短暂性脑缺血发作（TIA）、21例颅内出血和5例蛛网膜下腔出血）并收集了其临床特征。对缺血性中风和TIA（n = 133）分别进行分析。
159例患者的平均年龄为70.6岁，男性占66%。出院时40%（63/159）的患者预后较差（改良Rankin量表评分5 - 6分）。在缺血性中风和TIA患者中，分别有30%、18%、10%和42%的患者患有心源性栓塞、大动脉粥样硬化、小血管闭塞以及病因不明的隐源性中风或栓塞性中风。三分之一（34%）的患者出现颈内动脉、大脑中动脉M1段或基底动脉的大血管闭塞（LVO）。预后较差与年龄（调整比值比（aOR）：1.06，95%置信区间（CI）：1.01 - 1.12）、缺血性心脏病（IHD）病史（aOR：13.00，95%CI：1.51 - 111.70）、中度至重度肺炎（aOR：7.78，95%CI：1.18 - 51.42）、基线时的美国国立卫生研究院卒中量表评分（aOR：1.10，95%CI：1.03 - 1.17）以及LVO（aOR：14.88，9%CI：2.33 - 94.97）和log D - 二聚体（aOR：3.38，95%CI：1.01 - 11.26）有关。
出院时，40%的感染SARS-CoV-2的缺血性中风和TIA患者预后较差。预后较差与年龄较大、IHD病史、中度至重度肺炎、较高的美国国立卫生研究院卒中量表评分、LVO以及较高的log D - 二聚体有关。
UMIN临床试验注册中心：https://www.umin.ac.jp/ctr/。唯一标识符：UMIN000041226。
