Journal article
Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry
International journal of stroke, Vol.16(4), pp.437-447
09/30/2020
DOI: 10.1177/1747493020959216
PMID: 32852257
Abstract
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients.
To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease.
Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020-16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST).
Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130-280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19.
COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.
Details
- Title: Subtitle
- Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry
- Creators
- James E Siegler - Cooper Medical School of Rowan University, Camden NJ, USAÁngel Chamorro - Department of Neurology, Hospital Clínic, Barcelona, SpainSantiago Ortega-Gutierrez - Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USAPere Cardona - Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, SpainJuan F Arenillas - Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid, Consejo Superior de Investigaciones Científicas, Madrid, SpainMudassir Farooqui - Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USABlanca Talavera - Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, SpainAna N Guillen - Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, SpainAlba Chavarría-Miranda - Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, SpainMercedes de Lera - Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, SpainPriyank Khandelwal - Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid, Consejo Superior de Investigaciones Científicas, Madrid, SpainIvo Bach - Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, NJ, USAPratit Patel - Neurovascular Research Laboratory, Instituto de Biología y Genética Molecular, Universidad de Valladolid, Consejo Superior de Investigaciones Científicas, Madrid, SpainAmit Singla - New Jersey Medical School, Newark, NJ, USAManuel Requena - Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, SpainMarc Ribo - Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, SpainDinesh V Jillella - Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, SpainSrikant Rangaraju - Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, SpainRaul G Nogueira - Department of Neurology, Emory University School of Medicine, Atlanta, GA, USADiogo C Haussen - Department of Neurology, Emory University School of Medicine, Atlanta, GA, USAAlejandro R Vazquez - Department of Neurology, Grady Memorial Hospital, Atlanta, GA, USAXabier Urra - Department of Neurology, Hospital Clínic, Barcelona, SpainLuis S Román - Area of Neuroscience, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, SpainJesse M Thon - Cooper Medical School of Rowan University, Camden NJ, USARyna Then - Cooper Medical School of Rowan University, Camden NJ, USAEmma Sanborn - Cooper Medical School of Rowan University, Camden NJ, USANatalia P de la Ossa - Department of Radiology, Hospital Clínic, Barcelona, SpainMònica Millàn - Department of Radiology, Hospital Clínic, Barcelona, SpainIsaac N Ruiz - Department of Radiology, Hospital Clínic, Barcelona, SpainOssama Y Mansour - Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, Badalona, Barcelona, SpainMohammed Megahed - Department of Neurology, Stroke and Neurointervention division, Alexandria University, Alexandria, EgyptCristina Tiu - Department of Neurology, University Emergency Hospital Bucharest, Bucharest, RomaniaElena O Terecoasa - Department of Neurology, University Emergency Hospital Bucharest, Bucharest, RomaniaRăzvan A Radu - Department of Critical Care Medicine, Alexandria University, Alexandria, EgyptThanh N Nguyen - Department of Radiology, Boston Medical Center, Boston University School of Medicine, MA, USAGioacchino Curiale - "Carol Davila" University of Medicine and Pharmacy, Bucharest, RomaniaArtem Kaliaev - Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA, USAAlexandra L Czap - Department of Neurosurgery, Boston Medical Center, Boston University School of Medicine, MA, USAJacob Sebaugh - Department of Neurosurgery, Boston Medical Center, Boston University School of Medicine, MA, USAAlicia M Zha - Department of Neurosurgery, Boston Medical Center, Boston University School of Medicine, MA, USADavid S Liebeskind - Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USAAmeer E Hassan - Department of Clinical Neuroscience Research, Valley Baptist Medical Center, Harlingen, TX, USALaurie Preston - Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAMary S Patterson - Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX, USASaif Bushnaq - Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX, USAOsama Zaidat - Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX, USATudor G Jovin - Cooper Medical School of Rowan University, Camden NJ, USA
- Resource Type
- Journal article
- Publication Details
- International journal of stroke, Vol.16(4), pp.437-447
- DOI
- 10.1177/1747493020959216
- PMID
- 32852257
- NLM abbreviation
- Int J Stroke
- ISSN
- 1747-4930
- eISSN
- 1747-4949
- Publisher
- United States
- Language
- English
- Date published
- 09/30/2020
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984071695902771
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