Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry

• Type of Material: Article
• Authors: James E. Siegler, Cooper University Hospital; Pere Cardona, Hospital Universitari, Bellvitge, Barcelona, Spain; Juan F. Arenillas, Hospital Clinico Universitario de Valladolid; Blanca Talavera, Hospital Universitari, Bellvitge, Barcelona, Spain; Ana N. Guillen, Hospital Universitari, Bellvitge, Barcelona, Spain; Alba Chavarria-Miranda, Hospital Universitari, Bellvitge, Barcelona, Spain; Mercedes de Lera, Hospital Universitari, Bellvitge, Barcelona, Spain; Priyank Khandelwal, Universidad de Valladolid; Ivo Bach, Robert Wood Johnson University Hospital; Pratit Patel, Universidad de Valladolid; Amit Singla, New Jersey Medical School; Manuel Requena, Robert Wood Johnson University Hospital; Marc Ribo, Robert Wood Johnson University Hospital; Dinesh Jillella, Emory University; Srikant Rangaraju, Emory University; Raul Nogueira, Emory University; Diogo Haussen, Emory University; Alejandro R. Vazquez, Grady Memorial Hospital; Xabier Urra, Grady Memorial Hospital; Angel Chamorro, Grady Memorial Hospital; Luis S. Roman, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS); Jesse M. Thon, Cooper University Hospital; Ryna Then, Cooper University Hospital; Emma Sanborn, Cooper University Hospital; Natalia P. de la Ossa, Hospital Clinic Barcelona; Monica Millan, Hospital Clinic Barcelona; Isaac N. Ruiz, Hospital Clinic Barcelona; Ossama Y. Mansour, Hospital Universitari Germans Trias i Pujol; Mohammed Megahed, Alexandria University; Cristina Tiu, Alexandria University; Elena O. Terecoasa, Alexandria University; Razvan A. Radu, Alexandria University; Thanh N. Nguyen, Carol Davila University of Medicine & Pharmacy; Gioacchino Curiale, Carol Davila University of Medicine & Pharmacy; Artem Kaliaev, Boston University; Alexandra L. Czap, Boston University; Jacob Sebaugh, Boston University; Alicia M. Zha, Boston University; David S. Liebeskind, University of Texas Health Science Center at Houston; Santiago Ortega-Gutierrez, University of California Los Angeles; Mudassir Farooqui, University of California Los Angeles; Ameer E. Hassan, University of Iowa Hospitals and Clinics; Laurie Preston, University of Iowa Hospitals and Clinics; Mary S. Patterson, University of Texas Rio Grande Valley; Saif Bushnaq, University of Texas Rio Grande Valley; Osama Zaidat, University of Texas Rio Grande Valley; Tudor G. Jovin, Cooper University Hospital
• Language: English
• Date: 2020-09-30
• Publisher: SAGE Publications Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © 2020 World Stroke Organization.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/1747493020959216
• Title of Journal or Parent Work: International Journal of Stroke
• Volume: 16
• Issue: 4
• Start Page: 437
• End Page: 447
• Grant/Funding Information: The author(s) received no financial support for the research, authorship, and/or publication of this article.
• Keywords: Clinical Neurology; stroke; COVID-19; intracranial hemorrhage; Life Sciences & Biomedicine; Ischemic stroke; Cardiovascular System & Cardiology; cerebral venous thrombosis; Peripheral Vascular Disease; Science & Technology; Neurosciences & Neurology; All cerebrovascular diseases
• Research Categories: Biology, Neuroscience; Health Sciences, Radiology; Health Sciences, Medicine and Surgery

Abstract

Background Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aim To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods 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). Results 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. Conclusions 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.