Sebastian Fridman1, Maria Bres Bullrich1, Amado Jimenez-Ruiz2, Pablo Costantini3, Palak Shah, Caroline Just1, Daniel Vela-Duarte4, Italo Linfante4, Athena Sharifi-Razavi5, Narges Karimi6, Rodrigo Bagur7, Derek B Debicki1, Teneille E Gofton1, David A Steven1, Luciano A Sposato8,2,9,10,11,12. 1. Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. 2. Heart & Brain Laboratory, Western University, London, ON, Canada. 3. Instituto de Neurología y Neurocirugía de Neuquén, Neuquén, Argentina. 4. Miami Cardiac & Vascular Institute, Baptist Hospital Neuroscience Center, Miami, FL, USA. 5. Clinical Research Development Unit of Bou Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran. 6. Immunogenetics Research Center, Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 7. Department of Medicine, Division of Cardiology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. 8. Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Luciano.Sposato@LHSC.on.ca. 9. Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. 10. Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry. 11. Lawson Health Research Institute, London, ON, Canada. 12. Robarts Research Institute, Western University, London, ON, Canada.
Abstract
OBJECTIVES: To investigate the hypothesis that strokes occurring in patients with COVID-19 have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population. METHODS: We performed a systematic search resulting in 10 studies reporting stroke frequency among COVID-19 patients, which were pooled with one unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in COVID-19 patients (n=125) and we pooled these data with 35 unpublished cases from Canada, USA, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50-70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death. RESULTS: The proportion of COVID-19 patients with stroke (1.8%, 95%CI 0.9-3.7%) and in-hospital mortality (34.4%, 95%CI 27.2-42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years-old relative to those >70 years-old (OR 0.33, 95%CI 0.12-0.94, P=0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbidities. A clinical phenotype characterized by older age, a higher burden of comorbidities, and severe COVID-19 respiratory symptoms, was associated with the highest in-hospital mortality (58.6%) and a 3x higher risk of death than the rest of the cohort (OR 3.52, 95%CI 1.53-8.09, P=0.003). CONCLUSIONS: Stroke is relatively frequent among COVID-19 patients and has devastating consequences across all ages. The interplay of older age, comorbidities, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.
OBJECTIVES: To investigate the hypothesis that strokes occurring in patients with COVID-19 have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population. METHODS: We performed a systematic search resulting in 10 studies reporting stroke frequency among COVID-19patients, which were pooled with one unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in COVID-19patients (n=125) and we pooled these data with 35 unpublished cases from Canada, USA, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50-70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death. RESULTS: The proportion of COVID-19patients with stroke (1.8%, 95%CI 0.9-3.7%) and in-hospital mortality (34.4%, 95%CI 27.2-42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years-old relative to those >70 years-old (OR 0.33, 95%CI 0.12-0.94, P=0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbidities. A clinical phenotype characterized by older age, a higher burden of comorbidities, and severe COVID-19respiratory symptoms, was associated with the highest in-hospital mortality (58.6%) and a 3x higher risk of death than the rest of the cohort (OR 3.52, 95%CI 1.53-8.09, P=0.003). CONCLUSIONS:Stroke is relatively frequent among COVID-19patients and has devastating consequences across all ages. The interplay of older age, comorbidities, and severity of COVID-19respiratory symptoms is associated with an extremely elevated mortality.
Authors: Shubham Misra; Kavitha Kolappa; Manya Prasad; Divya Radhakrishnan; Kiran T Thakur; Tom Solomon; Benedict Daniel Michael; Andrea Sylvia Winkler; Ettore Beghi; Alla Guekht; Carlos A Pardo; Greta Karen Wood; Sherry Hsiang-Yi Chou; Ericka L Fink; Erich Schmutzhard; Amir Kheradmand; Fan Kee Hoo; Amit Kumar; Animesh Das; Achal K Srivastava; Ayush Agarwal; Tarun Dua; Kameshwar Prasad Journal: Neurology Date: 2021-10-11 Impact factor: 9.910
Authors: Carlos Castillo-Pinto; Guillaume Lamotte; Amit Mehta; Rajiv Sonti; Gianluca Di Maria; Daniel Ruiz; Princy N Kumar; Andrew B Stemer; M Carter Denny Journal: Neurohospitalist Date: 2020-11-10