Abstract
BackgroundThis study evaluates the mortality risk of patients with emergent large vessel occlusion (ELVO) and COVID-19 during the pandemic.MethodsWe performed a retrospective cohort study of two cohorts of consecutive patients with ELVO admitted to a quaternary hospital from March 1 to April 17, 2020. We abstracted data from electronic health records on baseline, biomarker profiles, key time points, quality measures and radiographic data.ResultsOf 179 patients admitted with ischemic stroke, 36 had ELVO. Patients with COVID-19 and ELVO had a higher risk of mortality during the pandemic versus patients without COVID-19 (OR 16.63, p = 0.004). An age-based sub-analysis showed in-hospital mortality in 60% of COVID-19 positive patients between 61-70 years-old, 66.7% in between 51-60 years-old, 50% in between 41-50 years-old and 33.3% in between 31-40 years old. Patients that presented with pulmonary symptoms at time of stroke presentation had 71.4% mortality rate. 27.3% of COVID-19 patients presenting with ELVO had a good outcome at discharge (mRS 0-2). Patients with a history of cigarette smoking (p = 0.003), elevated d-dimer (p = 0.007), failure to recanalize (p = 0.007), and elevated ferritin levels (p = 0.006) had an increased risk of mortality.ConclusionPatients with COVID-19 and ELVO had a significantly higher risk for mortality compared to COVID-19 negative patients with ELVO. A small percentage of COVID-19 ELVO patients had good outcomes. Age greater than 60 and pulmonary symptoms at presentation have higher risk for mortality. Other risk factors for mortality were a history of cigarette smoking, elevated, failure to recanalize, elevated d-dimer and ferritin levels.
Highlights
The novel coronavirus (COVID-19) is predominantly a disease affecting the lower respiratory tract, recent studies have reported neurological findings associated with this disease.[1,2] Two studies showed that cerebrovascular accidents were more common among severe COVID-19 patients.[2,3] A recent report from New York City described five cases of COVID-19 patients presenting with large vessel occlusion.[4]
We found a total of 36 patients with emergent large vessel occlusion (ELVO) during the entire study period, 36% (n 1⁄4 13) tested positive for COVID-19 (Table 1)
Patients with COVID-19 and ELVO had higher rates of in-hospital mortality (63% vs 9%, p 1⁄4 0.001) (Table 1). They had significantly higher mortality risk compared to patients without COVID-19 during the pandemic (OR: 16.63 95% CI: 2.47–111.79, p 1⁄4 0.004) (Table 1), still significant when adjusted for age and comorbidities (OR: 15.13 95% CI: 2.08–110.05, p 1⁄4 0.007)
Summary
The novel coronavirus (COVID-19) is predominantly a disease affecting the lower respiratory tract, recent studies have reported neurological findings associated with this disease.[1,2] Two studies showed that cerebrovascular accidents (mainly ischemic stroke) were more common among severe COVID-19 patients.[2,3] A recent report from New York City described five cases of COVID-19 patients presenting with large vessel occlusion.[4]. The aim of this study is to evaluate the impact of COVID-19 on patients with ELVO, as it relates to outcomes and mortality compared to patients without COVID-19 during the same epoch of time during the pandemic. This study evaluates the mortality risk of patients with emergent large vessel occlusion (ELVO) and COVID-19 during the pandemic. Patients with COVID-19 and ELVO had a higher risk of mortality during the pandemic versus patients without COVID-19 (OR 16.63, p 1⁄4 0.004). Patients with a history of cigarette smoking (p 1⁄4 0.003), elevated d-dimer (p 1⁄4 0.007), failure to recanalize (p 1⁄4 0.007), and elevated ferritin levels (p 1⁄4 0.006) had an increased risk of mortality. Other risk factors for mortality were a history of cigarette smoking, elevated, failure to recanalize, elevated d-dimer and ferritin levels
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