Héja Máté, Fekete István, Márton Sándor, Horváth László, Fekete Klára
Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Faculty of Arts, Institute of Political Science and Sociology, University of Debrecen, Debrecen, Hungary.
Sci Rep. 2024 Dec 28;14(1):31408. doi: 10.1038/s41598-024-83016-z.
The aim of this study was to evaluate how COVID-19 affected acute stroke care and outcome in patients with acute ischemic or hemorrhagic stroke. We performed a retrospective analysis on patients who were admitted with acute ischemic (AIS) or hemorrhagic (ICH) stroke from September 2020 to May 2021 with and without COVID-19. We recorded demographic and clinical data, imaging parameters, functional outcome and mortality at one year. Beside descriptive statistics we performed χ-probe, Mann-Witney U-test, Student t-probe and multivariate testing. We found a 29%-reduction in the number of AIS cases during the pandemic. The number of the large vessel occlusions /LVOs/ (N = 83, 41.7%), from them 37 (17.7%) had mechanical thrombectomy (MT), was higher than before the COVID-19 period (p = 0.02 and p = 0.001, respectively). From all patients needing acute revascularization therapy (N = 137) 118 patients received it, among them 20 (16.9%) had COVID-19. Those positive for COVID-19 were more likely to have a higher median NIHSS score at baseline and at 24 h (p = 0.02 and p = 0.03, respectively). They also had a lower rate of favourable outcome at discharge (15% vs. 41.8%; p = 0.024) and at three months (25% vs. 52%, p = 0.02), longer median hospitalization (p < 0.0001), and a higher mortality rate (52% vs. 25%; p = 0.03). The incidence of symptomatic intracerebral hemorrhage (sICH) did not differ between the groups. Regarding the ICH patients, NIHSS score at 24 h (p = 0.036), mortality at 3 months (p = 0.004) and at one year (p = 0.00) were higher in the COVID-19 group. We concluded that the pandemic resulted fewer admission due to AIS with an increased number of LVOs and MTs. AIS patients with concomitant SARS-CoV-2 infection have more severe strokes and unfavorable long term outcome. The risk of sICH was not increased in COVID-19 positive patients therefore reperfusion therapies appear to be safe and beneficial for some individuals. Patients with ICH and comorbid COVID-19 have a very poor prognosis.
本研究的目的是评估新型冠状病毒肺炎（COVID-19）如何影响急性缺血性或出血性中风患者的急性中风护理及预后。我们对2020年9月至2021年5月期间因急性缺血性中风（AIS）或出血性中风（ICH）入院的患者进行了回顾性分析，这些患者有的感染了COVID-19，有的未感染。我们记录了患者的人口统计学和临床数据、影像学参数、1年时的功能预后和死亡率。除了描述性统计分析外，我们还进行了χ检验、曼-惠特尼U检验、学生t检验和多变量检验。我们发现疫情期间AIS病例数减少了29%。大血管闭塞（LVO）的病例数（N = 83，41.7%），其中37例（17.7%）接受了机械取栓术（MT），高于COVID-19疫情之前（p值分别为0.02和0.001）。在所有需要急性血运重建治疗的患者（N = 137）中，118例患者接受了治疗，其中20例（16.9%）感染了COVID-19。COVID-19检测呈阳性的患者在基线和24小时时更有可能具有较高的美国国立卫生研究院卒中量表（NIHSS）中位数评分（p值分别为0.02和0.03）。他们出院时（15%对41.8%；p = 0.024）和3个月时（25%对52%，p = 0.02）预后良好的比例也较低，住院中位数更长（p < 0.0001），死亡率更高（52%对25%；p = 0.03）。有症状性脑出血（sICH）的发生率在两组之间没有差异。对于ICH患者，COVID-19组在24小时时的NIHSS评分（p = 0.036）、3个月时（p = 0.004）和1年时（p = 0.00）的死亡率更高。我们得出结论，疫情导致因AIS入院的患者减少，同时LVO和MT的数量增加。合并SARS-CoV-2感染的AIS患者中风更严重，长期预后不佳。COVID-19阳性患者发生sICH的风险并未增加，因此再灌注治疗似乎对某些个体是安全且有益的。合并COVID-19的ICH患者预后非常差。
