Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry

Abstract Background and purpose Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cr...

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Main Authors: María E. Ramos-Araque, James E. Siegler, Marc Ribo, Manuel Requena, Cristina López, Mercedes de Lera, Juan F. Arenillas, Isabel Hernández Pérez, Beatriz Gómez-Vicente, Blanca Talavera, Pere Cardona Portela, Ana Nuñez Guillen, Xabier Urra, Laura Llull, Arturo Renú, Thanh N. Nguyen, Dinesh Jillella, Fadi Nahab, Raul Nogueira, Diogo Haussen, Ryna Then, Jesse M. Thon, Luis Rodríguez Esparragoza, Maria Hernández-Pérez, Alejandro Bustamante, Ossama Yassin Mansour, Mohammed Megahed, Tamer Hassan, David S. Liebeskind, Ameer Hassan, Saif Bushnaq, Mohamed Osman, Alejandro Rodriguez Vazquez, SVIN Multinational Registry and Task Force
Format: Article
Language:English
Published: BMC 2021-01-01
Series:BMC Neurology
Subjects:
Online Access:https://doi.org/10.1186/s12883-021-02075-1
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author María E. Ramos-Araque
James E. Siegler
Marc Ribo
Manuel Requena
Cristina López
Mercedes de Lera
Juan F. Arenillas
Isabel Hernández Pérez
Beatriz Gómez-Vicente
Blanca Talavera
Pere Cardona Portela
Ana Nuñez Guillen
Xabier Urra
Laura Llull
Arturo Renú
Thanh N. Nguyen
Dinesh Jillella
Fadi Nahab
Raul Nogueira
Diogo Haussen
Ryna Then
Jesse M. Thon
Luis Rodríguez Esparragoza
Maria Hernández-Pérez
Alejandro Bustamante
Ossama Yassin Mansour
Mohammed Megahed
Tamer Hassan
David S. Liebeskind
Ameer Hassan
Saif Bushnaq
Mohamed Osman
Alejandro Rodriguez Vazquez
SVIN Multinational Registry and Task Force
spellingShingle María E. Ramos-Araque
James E. Siegler
Marc Ribo
Manuel Requena
Cristina López
Mercedes de Lera
Juan F. Arenillas
Isabel Hernández Pérez
Beatriz Gómez-Vicente
Blanca Talavera
Pere Cardona Portela
Ana Nuñez Guillen
Xabier Urra
Laura Llull
Arturo Renú
Thanh N. Nguyen
Dinesh Jillella
Fadi Nahab
Raul Nogueira
Diogo Haussen
Ryna Then
Jesse M. Thon
Luis Rodríguez Esparragoza
Maria Hernández-Pérez
Alejandro Bustamante
Ossama Yassin Mansour
Mohammed Megahed
Tamer Hassan
David S. Liebeskind
Ameer Hassan
Saif Bushnaq
Mohamed Osman
Alejandro Rodriguez Vazquez
SVIN Multinational Registry and Task Force
Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry
BMC Neurology
Stroke
COVID-19
Coronavirus
Cryptogenic
Mortality
author_facet María E. Ramos-Araque
James E. Siegler
Marc Ribo
Manuel Requena
Cristina López
Mercedes de Lera
Juan F. Arenillas
Isabel Hernández Pérez
Beatriz Gómez-Vicente
Blanca Talavera
Pere Cardona Portela
Ana Nuñez Guillen
Xabier Urra
Laura Llull
Arturo Renú
Thanh N. Nguyen
Dinesh Jillella
Fadi Nahab
Raul Nogueira
Diogo Haussen
Ryna Then
Jesse M. Thon
Luis Rodríguez Esparragoza
Maria Hernández-Pérez
Alejandro Bustamante
Ossama Yassin Mansour
Mohammed Megahed
Tamer Hassan
David S. Liebeskind
Ameer Hassan
Saif Bushnaq
Mohamed Osman
Alejandro Rodriguez Vazquez
SVIN Multinational Registry and Task Force
author_sort María E. Ramos-Araque
title Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry
title_short Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry
title_full Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry
title_fullStr Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry
title_full_unstemmed Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry
title_sort stroke etiologies in patients with covid-19: the svin covid-19 multinational registry
publisher BMC
series BMC Neurology
issn 1471-2377
publishDate 2021-01-01
description Abstract Background and purpose Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. Methods We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20–6/16/20). Results Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41–18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35–3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02–1.21, p = 0.01) were also independently predictive of mortality. Conclusions Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.
topic Stroke
COVID-19
Coronavirus
Cryptogenic
Mortality
url https://doi.org/10.1186/s12883-021-02075-1
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spelling doaj-1bc4573ed0e442738194399bc3da5dde2021-01-31T16:12:54ZengBMCBMC Neurology1471-23772021-01-0121111110.1186/s12883-021-02075-1Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registryMaría E. Ramos-Araque0James E. Siegler1Marc Ribo2Manuel Requena3Cristina López4Mercedes de Lera5Juan F. Arenillas6Isabel Hernández Pérez7Beatriz Gómez-Vicente8Blanca Talavera9Pere Cardona Portela10Ana Nuñez Guillen11Xabier Urra12Laura Llull13Arturo Renú14Thanh N. Nguyen15Dinesh Jillella16Fadi Nahab17Raul Nogueira18Diogo Haussen19Ryna Then20Jesse M. Thon21Luis Rodríguez Esparragoza22Maria Hernández-Pérez23Alejandro Bustamante24Ossama Yassin Mansour25Mohammed Megahed26Tamer Hassan27David S. Liebeskind28Ameer Hassan29Saif Bushnaq30Mohamed Osman31Alejandro Rodriguez Vazquez32SVIN Multinational Registry and Task ForceInstitute of Biomedical Research of Salamanca, Department of Neurology, Hospital Universitario de SalamancaCooper Neurologic Institute, Cooper University HospitalStroke Unit, Department of Neurology, Vall d’Hebron Research InstituteStroke Unit, Department of Neurology, Vall d’Hebron Research InstituteDepartment of Neurology, Hospital Clínico Universitario de ValladolidDepartment of Neurology, Hospital Clínico Universitario de ValladolidDepartment of Neurology, Hospital Clínico Universitario de ValladolidDepartment of Neurology, Hospital Clínico Universitario de ValladolidDepartment of Neurology, Hospital Clínico Universitario de ValladolidDepartment of Neurology, Hospital Clínico Universitario de ValladolidDepartment of Neurology, Hospital UniversitariDepartment of Neurology, Hospital UniversitariDepartment of Neurology, Hospital ClínicDepartment of Neurology, Hospital ClínicDepartment of Neurology, Hospital ClínicDepartment of Neurology, Department of Radiology, Department of Neurosurgery, Boston Medical Center, Boston University School of MedicineDepartment of Neurology, Emory University School of MedicineDepartment of Neurology, Emory University School of MedicineDepartment of Neurology, Grady Memorial HospitalDepartment of Neurology, Grady Memorial HospitalCooper Neurologic Institute, Cooper University HospitalCooper Neurologic Institute, Cooper University HospitalStroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i PujolStroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i PujolStroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i PujolNeurology Department, Stroke and neurointervention unit, Alexandria UniversityCritical care Department, Alexandria UniversityNeurosurgery Department, Stroke and Neurointervention unit, Alexandria UniversityDepartment of Neurology, Ronald Reagan UCLA Medical CenterDepartment of Clinical Neuroscience Research, Valley Baptist Medical CenterNeuroscience Institute, Bon Secours Mercy Health St. Vincent HospitalNeuroscience Institute, Bon Secours Mercy Health St. Vincent HospitalDepartment of Neurology, Hospital ClínicAbstract Background and purpose Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. Methods We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20–6/16/20). Results Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41–18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35–3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02–1.21, p = 0.01) were also independently predictive of mortality. Conclusions Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.https://doi.org/10.1186/s12883-021-02075-1StrokeCOVID-19CoronavirusCryptogenicMortality