TY - JOUR
T1 - Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19
T2 - A Multicenter Cohort Study
AU - CAPACITY-COVID Collaborative Consortium
AU - Sluis, Wouter M
AU - Linschoten, Marijke
AU - Buijs, Julie E
AU - Biesbroek, J Matthijs
AU - den Hertog, Heleen M
AU - Ribbers, Tessa
AU - Nieuwkamp, Dennis J
AU - van Houwelingen, Reinier C
AU - Dias, Andreas
AU - van Uden, Ingeborg W M
AU - Kerklaan, Joost P
AU - Bienfait, H Paul
AU - Vermeer, Sarah E
AU - de Jong, Sonja W
AU - Ali, Mariam
AU - Wermer, Marieke J H
AU - de Graaf, Marieke T
AU - Brouwers, Paul J A M
AU - Asselbergs, Folkert W
AU - Kappelle, L Jaap
AU - van der Worp, H Bart
AU - Algra, Annemijn M
PY - 2021/12
Y1 - 2021/12
N2 - BACKGROUND AND PURPOSE: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19.METHODS: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke.RESULTS: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke.CONCLUSIONS: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.
AB - BACKGROUND AND PURPOSE: The frequency of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) varies in the current literature, and risk factors are unknown. We assessed the incidence, risk factors, and outcomes of acute ischemic stroke in hospitalized patients with COVID-19.METHODS: We included patients with a laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection admitted in 16 Dutch hospitals participating in the international CAPACITY-COVID registry between March 1 and August 1, 2020. Patients were screened for the occurrence of acute ischemic stroke. We calculated the cumulative incidence of ischemic stroke and compared risk factors, cardiovascular complications, and in-hospital mortality in patients with and without ischemic stroke.RESULTS: We included 2147 patients with COVID-19, of whom 586 (27.3%) needed treatment at an intensive care unit. Thirty-eight patients (1.8%) had an ischemic stroke. Patients with stroke were older but did not differ in sex or cardiovascular risk factors. Median time between the onset of COVID-19 symptoms and diagnosis of stroke was 2 weeks. The incidence of ischemic stroke was higher among patients who were treated at an intensive care unit (16/586; 2.7% versus nonintensive care unit, 22/1561; 1.4%; P=0.039). Pulmonary embolism was more common in patients with (8/38; 21.1%) than in those without stroke (160/2109; 7.6%; adjusted risk ratio, 2.08 [95% CI, 1.52-2.84]). Twenty-seven patients with ischemic stroke (71.1%) died during admission or were functionally dependent at discharge. Patients with ischemic stroke were at a higher risk of in-hospital mortality (adjusted risk ratio, 1.56 [95% CI, 1.13-2.15]) than patients without stroke.CONCLUSIONS: In this multicenter cohort study, the cumulative incidence of acute ischemic stroke in hospitalized patients with COVID-19 was ≈2%, with a higher risk in patients treated at an intensive care unit. The majority of stroke patients had a poor outcome. The association between ischemic stroke and pulmonary embolism warrants further investigation.
KW - Age Factors
KW - Aged
KW - Aged, 80 and over
KW - COVID-19/epidemiology
KW - Cohort Studies
KW - Female
KW - Functional Status
KW - Hospital Mortality
KW - Hospitalization
KW - Humans
KW - Incidence
KW - Intensive Care Units
KW - Ischemic Stroke/epidemiology
KW - Male
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Prognosis
KW - Pulmonary Embolism/epidemiology
KW - Risk Factors
KW - SARS-CoV-2
U2 - https://doi.org/10.1161/STROKEAHA.121.034787
DO - https://doi.org/10.1161/STROKEAHA.121.034787
M3 - Article
C2 - 34732073
SN - 0039-2499
VL - 52
SP - 3978
EP - 3986
JO - Stroke
JF - Stroke
IS - 12
ER -