Abstract
ObjectiveTo characterize patients with acute ischemic stroke related to SARS-CoV-2 infection and assess the classification performance of clinical and laboratory parameters in predicting in-hospital outcome of these patients.MethodsIn the setting of the STROKOVID study including patients with acute ischemic stroke consecutively admitted to the ten hub hospitals in Lombardy, Italy, between March 8 and April 30, 2020, we compared clinical features of patients with confirmed infection and non-infected patients by logistic regression models and survival analysis. Then, we trained and tested a random forest (RF) binary classifier for the prediction of in-hospital death among patients with COVID-19.ResultsAmong 1013 patients, 160 (15.8%) had SARS-CoV-2 infection. Male sex (OR 1.53; 95% CI 1.06–2.27) and atrial fibrillation (OR 1.60; 95% CI 1.05–2.43) were independently associated with COVID-19 status. Patients with COVID-19 had increased stroke severity at admission [median NIHSS score, 9 (25th to75th percentile, 13) vs 6 (25th to75th percentile, 9)] and increased risk of in-hospital death (38.1% deaths vs 7.2%; HR 3.30; 95% CI 2.17–5.02). The RF model based on six clinical and laboratory parameters exhibited high cross-validated classification accuracy (0.86) and precision (0.87), good recall (0.72) and F1-score (0.79) in predicting in-hospital death.ConclusionsIschemic strokes in COVID-19 patients have distinctive risk factor profile and etiology, increased clinical severity and higher in-hospital mortality rate compared to non-COVID-19 patients. A simple model based on clinical and routine laboratory parameters may be useful in identifying ischemic stroke patients with SARS-CoV-2 infection who are unlikely to survive the acute phase.
Highlights
With the increasing number of confirmed cases of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), andMaria Sessa and Alessandro Padovani contributed to the study.Extended author information available on the last page of the article the accumulating clinical data, it is well established that, in addition to the predominant respiratory symptoms, a significant proportion of COVID-19 patients has extrapulmonary manifestations, including thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, such as acute stroke, ocular symptoms, and dermatologic complications [1, 2]
We aimed to fill the gap by investigating these issues in the setting of the STROKOVID project, a multicentre study conducted in Lombardy, Northern Italy, one of the largest registries including patients with COVID-19 and acute ischemic stroke that is currently available
Because of the spread of the epidemic, on March 8, 2020, the Lombardy regional government passed a deliberation to reduce to ten the hospitals with catheterization facilities for the treatment of acute ischemic stroke acting as hubs, with the remaining hospitals acting as spokes, on the basis of geographic proximity
Summary
With the increasing number of confirmed cases of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), andMaria Sessa and Alessandro Padovani contributed to the study.Extended author information available on the last page of the article the accumulating clinical data, it is well established that, in addition to the predominant respiratory symptoms, a significant proportion of COVID-19 patients has extrapulmonary manifestations, including thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, such as acute stroke, ocular symptoms, and dermatologic complications [1, 2]. With the increasing number of confirmed cases of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and. Many currently available data are derived from studies comparing patients with stroke and historical controls [4,5,6]. Such an approach does not allow to exclude a potential bias since historical controls tend to have less severe strokes than those observed among contemporaneous controls [7,8,9,10]. We aimed to fill the gap by investigating these issues in the setting of the STROKOVID project, a multicentre study conducted in Lombardy, Northern Italy, one of the largest registries including patients with COVID-19 and acute ischemic stroke that is currently available
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