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Stroke risk, phenotypes, and death in COVID-19

2020; Lippincott Williams & Wilkins; Volume: 95; Issue: 24 Linguagem: Inglês

10.1212/wnl.0000000000010851

1526-632X

Sebastián Fridman, María Bres Bullrich, Amado Jiménez‐Ruiz, Pablo Costantini, Palak Shah, Caroline Just, Daniel Vela‐Duarte, Italo Linfante, Athena Sharifi‐Razavi, Narges Karimi, Rodrigo Bagur, Derek Debicki, Teneille Gofton, David A. Steven, Luciano A. Sposato,

COVID-19 and healthcare impacts

To investigate the hypothesis that strokes occurring in patients with coronavirus disease 2019 (COVID-19) have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population.We performed a systematic search resulting in 10 studies reporting stroke frequency among patients with COVID-19, which were pooled with 1 unpublished series from Canada.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systematic search for cases series of stroke in patients with COVID-19 (n = 125), and we pooled these data with 35 unpublished cases from Canada, the United States, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups ( 70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death.The proportions of patients with COVID-19 with stroke (1.8%, 95% confidence interval [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 70 years of age (odds ratio [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 comorbid conditions. A clinical phenotype characterized by older age, a higher burden of comorbid conditions, and severe COVID-19 respiratory symptoms was associated with the highest in-hospital mortality (58.6%) and a 3 times higher risk of death than the rest of the cohort (OR 3.52, 95% CI 1.53-8.09, p = 0.003).Stroke is relatively frequent among patients with COVID-19 and has devastating consequences across all ages. The interplay of older age, comorbid conditions, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.