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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2021-01-01
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Series: | BMC Neurology |
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Online Access: | https://doi.org/10.1186/s12883-021-02075-1 |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
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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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 |