Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort Study
CAPACITY-COVID collaborative consortium
(2021) Stroke, volume 52, issue 12, pp. 3978 - 3986
(Article)
Abstract
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
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(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.
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Keywords: COVID-19, Hospital mortality, Incidence, Intensive care units, Patient discharge, Pulmonary embolism, Clinical Neurology, Cardiology and Cardiovascular Medicine, Advanced and Specialised Nursing
ISSN: 0039-2499
Publisher: Lippincott Williams and Wilkins
Note: Funding Information: This work was supported by the Dutch Heart Foundation (2020B006 CAPACITY), Novartis Global, Novo Nordisk Nederland, Servier Nederland, and Daiichi Sankyo Nederland. Funding Information: This work was supported by the Dutch Heart Foundation (2020B006 CAPACITY), Novartis Global, Novo Nordisk Nederland, Servier Nederland, and Daiichi Sankyo Nederland. Funding Information: Dr Sluis is supported by the European Union’s Horizon 2020 Research and Innovation Programme (grant No. 634809). Dr Linschoten is supported by the Alexandre Suerman Stipend of the University Medical Center Utrecht. Dr Asselbergs is supported by the University College London Hospitals National Institute for Health Research Biomedical Research and CardioVasculair Onderzoek Nederland 2015-12 eDETECT. Dr Wermer is supported by a grant from the Dutch Heart Foundation (Dr Dekker grant 2016T086), a VIDI grant from ZonMw/NWO (91717337), and a grant for CORONIS from ZonMW and the Dutch Heart Foundation. She served as a consultant for Biogen without payment. Dr van der Worp reports a grant from ZonMW for CORONIS during the conduct of the study, grants from Stryker outside the submitted work, and served as a consultant to Bayer and LivaNova, with fees paid to his institution. He participates in a different observational study assessing the impact of coronavirus disease 2019 (COVID-19) on cerebral ischemic lesions. Dr Algra is supported by a grant from the Dutch Heart Foundation (Dr Dekker grant 2016T023). The other authors report no conflicts. Publisher Copyright: © 2021 American Heart Association, Inc.
(Peer reviewed)