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Comparative Study
Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry.
- María E Ramos-Araque, James E Siegler, Marc Ribo, Manuel Requena, Cristina López, Mercedes de Lera, Juan F Arenillas, Isabel Hernández Pérez, Beatriz Gómez-Vicente, Blanca Talavera, Pere Cardona Portela, Ana Nuñez Guillen, Xabier Urra, Laura Llull, Arturo Renú, Thanh N Nguyen, Dinesh Jillella, Fadi Nahab, Raul Nogueira, Diogo Haussen, Ryna Then, Jesse M Thon, Luis Rodríguez Esparragoza, Maria Hernández-Pérez, Alejandro Bustamante, Ossama Yassin Mansour, Mohammed Megahed, Tamer Hassan, David S Liebeskind, Ameer Hassan, Saif Bushnaq, Mohamed Osman, Alejandro Rodriguez Vazquez, and SVIN Multinational Registry and Task Force.
- Institute of Biomedical Research of Salamanca, Department of Neurology, Hospital Universitario de Salamanca, Salamanca, Spain.
- Bmc Neurol. 2021 Jan 30; 21 (1): 43.
Background And PurposeCoronavirus 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.MethodsWe 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).ResultsOf 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.ConclusionsOur findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.
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