| Resum: |
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020-16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1. 13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40. 5%) were female and 96/172 (55. 8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1. 08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0. 19%; 190/100,000 95%CI 130-280/100,000), and 3 with CVST (0. 02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38. 1% and for ICH 58. 3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0. 1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5. 01, 95%CI 1. 63-15. 44, p < 0. 01), older age (aOR 1. 78, 95%CI 1. 07-2. 94, p = 0. 03), and lower lymphocyte count on admission (aOR 0. 58, 95%CI 0. 34-0. 98, p = 0. 04) were the only independent predictors of mortality among patients with stroke and COVID-19. COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes. |
visitant ::
identificació
(Cooper Medical School of Rowan University)
