Acute ischaemic stroke associated with SARS-CoV-2 infection in North America
Adam A. Dmytriw, Mahmoud Dibas, Kevin Phan, Aslan Efendizade, Johanna Ospel, Clemens M. Schirmer, Fabio Settecase, Manraj K.S. Heran, Anna Luisa Kühn, Ajit S Puri, Bijoy K. Menon, Sanjeev Sivakumar, Askan Mowla, Daniel Vela‐Duarte, Italo Linfante, Guilherme Dabus, Robert W. Regenhardt, Salvatore D’Amato, Joseph Rosenthal, Alicia Zha, Nafee T. Talukder, Sunil A. Sheth, Ameer E Hassan, Daniel L. Cooke, Lester Y. Leung, Adel M. Malek, Barbara Voetsch, Siddharth Sehgal, Ajay K. Wakhloo, Mayank Goyal, Hannah Wu, Jake Cohen, Sherief Ghozy, David Turkel‐Parella, Zerwa Farooq, Justin E. Vranic, James D. Rabinov, Christopher J. Stapleton, Ramandeep Minhas, Vinodkumar Velayudhan, Zeshan A. Chaudhry, Andrew Xavier, María Bres Bullrich, Sachin Pandey, Luciano A. Sposato, Stephen A. Johnson, Gaurav Gupta, Priyank Khandelwal, Latisha K. Ali, David S. Liebeskind, Mudassir Farooqui, Santiago Ortega‐Gutiérrez, Fadi Nahab, Dinesh Jillella, Karen Chen, Mohammad Ali Aziz‐Sultan, Mohamad Abdalkader, Artem Kaliaev, Thanh N. Nguyen, Diogo C Haussen, Raul G. Nogueira, Israr Ul Haq, Osama O. Zaidat, Emma Sanborn, Thabele M Leslie‐Mazwi, Aman B. Patel, James E. Siegler, Ambooj Tiwari
Abstract
BACKGROUND: To analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome. METHODS: Multicentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications. RESULTS: A total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, p<0.001), diabetes mellitus (aOR: 2.66, 95% CI 1.16 to 6.09, p=0.021), higher NIHSS at admission (aOR: 1.08, 95% CI 1.02 to 1.14, p=0.006), LVO (aOR: 2.45, 95% CI 1.04 to 5.78, p=0.042), and higher NLR level (aOR: 1.06, 95% CI 1.01 to 1.11, p=0.028) were significantly associated with poor functional outcome. CONCLUSION: There is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.