• Adam A Dmytriw, Mahmoud Dibas, Kevin Phan, Aslan Efendizade, Johanna Ospel, Clemens Schirmer, Fabio Settecase, HeranManraj K SMKSDivision of Neuroradiology, Vancouver General Hospital, Vancouver, BC, Canada., Anna Luisa Kühn, Ajit S Puri, Bijoy K Menon, Sanjeev Sivakumar, Askan Mowla, Daniel Vela-Duarte, Italo Linfante, Guilherme C Dabus, Robert W Regenhardt, Salvatore D'Amato, Joseph A Rosenthal, Alicia Zha, Nafee 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 Ahmed Chaudhry, Andrew Xavier, BullrichMaria BresMBDepartments of Neurology & Neuroradiology, London Health Sciences Centre, London, Ontario, Canada., Sachin Pandey, Luciano A Sposato, Stephen A Johnson, Gaurav Gupta, Priyank Khandelwal, Latisha Ali, David S Liebeskind, Mudassir Farooqui, Santiago Ortega-Gutierrez, Fadi Nahab, Dinesh V 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, and North American Neurovascular COVID-19 (NAN-C) Consortium & Society of Vascular and Interventional Neurology (SVIN) Investigators.
• Neuroradiology, Neurosurgery & Neurology Services, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA admytriw@mgh.harvard.edu.
• J. Neurol. Neurosurg. Psychiatr. 2022 Apr 1; 93 (4): 360368360-368.

BackgroundTo analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome.MethodsMulticentre 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.ResultsA 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.ConclusionThere 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.© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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