Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort Study.

Autor:	Sluis WM; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands., Linschoten M; Department of Cardiology, Division of Heart and Lungs (M.L., F.W.A.), University Medical Center Utrecht, Utrecht University, the Netherlands., Buijs JE; Department of Neurology, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands (J.E.B.)., Biesbroek JM; Department of Neurology, Diakonessenhuis Hospital, Utrecht, the Netherlands (J.M.B.)., den Hertog HM; Department of Neurology, Isala Hospital, Zwolle, the Netherlands (H.M.d.H.)., Ribbers T; Department of Neurology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands (T.R., D.J.N.)., Nieuwkamp DJ; Department of Neurology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands (T.R., D.J.N.)., van Houwelingen RC; Department of Neurology, Treant Hospital, Emmen, the Netherlands (R.C.v.H.)., Dias A; Department of Neurology, Ikazia Hospital, Rotterdam, the Netherlands (A.D.)., van Uden IWM; Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands (I.W.M.v.U.)., Kerklaan JP; Department of Neurology, St. Antonius Hospital, Nieuwegein, the Netherlands (J.P.K.)., Bienfait HP; Department of Neurology, Gelre Hospital, Apeldoorn, the Netherlands (H.P.B.)., Vermeer SE; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands (S.E.V.)., de Jong SW; Department of Neurology, St. Jansdal Hospital, Harderwijk, the Netherlands (S.W.d.J.)., Ali M; Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A.)., Wermer MJH; Department of Neurology, Leiden University Medical Center, the Netherlands (M.J.H.W.)., de Graaf MT; Department of Neurology, Zaans Medisch Centrum, Zaandam, the Netherlands (M.T.d.G.)., Brouwers PJAM; Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands (P.J.A.M.B.)., Asselbergs FW; Department of Cardiology, Division of Heart and Lungs (M.L., F.W.A.), University Medical Center Utrecht, Utrecht University, the Netherlands.; Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.), University College London, United Kingdom.; Health Data Research UK and Institute of Health Informatics (F.W.A.), University College London, United Kingdom., Kappelle LJ; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands., van der Worp HB; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands., Algra AM; Department of Neurology and Neurosurgery, UMC Utrecht Brain Center (W.M.S., L.J.K., H.B.v.d.W., A.M.A.), University Medical Center Utrecht, Utrecht University, the Netherlands.
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2021 Dec; Vol. 52 (12), pp. 3978-3986. Date of Electronic Publication: 2021 Nov 04.
DOI:	10.1161/STROKEAHA.121.034787
Abstrakt:	Background and Purpose: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19. Methods: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke. Results: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P =0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke. Conclusions: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.
Databáze:	MEDLINE
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