Abstract
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.
Highlights
Since December 2019, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a pandemic infecting more than 81 million people worldwide and causing more than 1.700.000 deaths [1]
The aim of this study was to characterize clinical, radiographic, and laboratory predictors of cryptogenic stroke using a multinational registry, and to evaluate shortterm outcomes of patients with SARS-CoV-2 associated stroke according to traditional stroke mechanisms
Antecedent systemic symptoms were reported with variable frequency but included fever in 69/134 patients (51%), 77/133 (58%) with cough, 60/128 (47%) dyspnea, 21/112 (19%) chest pain, 18/107 (17%) myalgias, 12/110 (11%) headache, and < 10% with symptoms of congestion, dizziness, odynophagia, hyposmia, or hypogeusia
Summary
Since December 2019, coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a pandemic infecting more than 81 million people worldwide and causing more than 1.700.000 deaths [1]. Respiratory symptoms are most commonly reported, neurological symptoms are increasingly recognized, and range from 36 to 56% according to large series of hospitalized patients [2,3,4], with a small but clinically significant risk of acute ischemic stroke (AIS) [5,6,7]. The aim of this study was to characterize clinical, radiographic, and laboratory predictors of cryptogenic stroke using a multinational registry, and to evaluate shortterm outcomes of patients with SARS-CoV-2 associated stroke according to traditional stroke mechanisms. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and inhospital mortality among patients according to stroke etiology
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