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

2021; BioMed Central; Volume: 21; Issue: 1 Linguagem: Inglês

10.1186/s12883-021-02075-1

1471-2377

María E. Ramos-Araque, James E. Siegler, Marc Ribó, Manuel Requena, Cristina López, Mercedes de Lera, Juan F. Arenillas, Isabel Hernández Pérez, Beatriz Gómez‐Vicente, Blanca Talavera, Pere‐Joan Cardona, Ana Nuñez Guillen, Xabier Urra, Laura Llull, Arturo Renú, Thanh N. Nguyen, Dinesh Jillella, Fadi Nahab, Raul G. Nogueira, Diogo C Haussen, Ryna Then, Jesse Thon, Luis Rodríguez Esparragoza, María Hernández‐Pérez, Alejandro Bustamante, Malek Mansour, Mohammed Megahed, Tamer Hassan, David S. Liebeskind, Ameer E Hassan, Saif Bushnaq, Mohamed Osman, Alejandro Rodríguez Vázquez,

Acute Ischemic Stroke Management

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.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).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.Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.