Background and purpose Since the outbreak of the coronavirus pandemic in 2019 (COVID-19), healthcare systems around the world have been hit to varying degrees. As a neurologist team, for patients with acute ischemic stroke (AIS), we compared the situations of intravenous thrombolysis (IVT) treatment from 2019 to 2020 to investigate the influence of COVID-19 pandemic on the attendance and prognosis of the IVT patients. Methods We collected the messages of objects who had received IVT (Bridging surgery was ruled out) during 2019–2020. We analyzed differences in age, gender, time from onset to start IVT, door to needle time (DNT), pretreatment NIHSS score, postoperative NIHSS score, and so on. Statistical tests were also performed to respectively compare the discharged modified Rankin score (mRS) and discharged NIHSS score between two years. Results Since the onset of COVID-19 restrictions in Wenzhou, we observed a significant reduction of 24.7% ( p = 0.023) from 267(2019) to 201(2020) of received IVT on hospital admission. We compared the DNT between two years and it reflected that the DNT (min) in 2020 was obviously longer than in 2019 (51.60 ± 23.80 vs 46.80 ± 21.90, p = 0.026). We also compared the discharged mRS, which reflected much more IVT patients in 2020 during the COVID-19 pandemic had a poor short-term functional prognosis (38.2% vs 29.2%, p = 0.043). Conclusions The COVID-19 pandemic caused the decrease of admissions and prolonged the time of the green channel for stroke, which led to the worse short-term prognosis of AIS patients during the pandemic. It’s necessary to ensure an effective green channel and provide adequate medical resources during the pandemic period to reduce the damage caused by COVID-19.

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BackgroundPoor sleep quality and vitamin D deficiency are common in stroke patients. Our aim was to evaluate the possible association between vitamin D and sleep quality in acute ischemic stroke (AIS) patients.MethodsA total of 301 AIS patients were screened and completed 1-month follow-up. Serum 25-hydroxyvitamin D [25(OH)D] was used to assess the vitamin D status by a competitive protein-binding assay at baseline. All patients were divided into equal quartile according to the distribution of 25(OH)D. One month after stroke, sleep quality was evaluated by using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaire; depression status was confirmed by 17-item Hamilton Depression Scale (HAMD).ResultsThere were 89 (29.6%) AIS patients with poor sleep quality 1-month post-event. Within 24 h after admission, serum 25(OH)D levels were significantly lower in patients with poor sleep quality after stroke (P < 0.001). In the results of multivariate-adjusted logistic regression analysis, the odds ratio (OR) of poor sleep quality was 6.199 (95% CI, 2.066–18.600) for the lowest quartile of 25(OH)D compared with the highest quartile. In patients without depression, reduced 25(OH)D were still significantly associated with poor sleep quality (OR = 8.174, 95% CI = 2.432–27.473). Furthermore, 25(OH)D and HAMD score were combined to enhance the diagnostic accuracy of poor sleep quality, with the area under the receiver operating characteristic curve of 0.775.ConclusionReduced serum levels of vitamin D at admission were independently and significantly associated with poor sleep quality at 1 month after stroke. Our findings suggested the combination of vitamin D and depression status could provide important predictive information for post-stroke sleep quality.

Background and Purpose In patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT), there are few studies assessing the predictive effect of blood cell inflammatory markers on stroke-associated pneumonia (SAP), short-term and long-term prognosis. In this study, we evaluated whether the neutrophil-to-lymphocyte ratio (NLR) can predict SAP and functional prognosis in patients receiving IVT. Methods We assessed 388 patients undergoing IVT for acute ischemic stroke. Blood parameters were sampled before thrombolysis (within 30 mins after admission) and within 12–24 h after thrombolysis. The primary outcome measure was the occurrence of SAP as well as the prognosis after IVT. Multivariate logistic regression analysis was performed to analyze the association between NLR and the occurrence of SAP. We also used receiver operating characteristic curve analysis to assess the discriminative ability of NLR measured at different times in predicting SAP and prognosis. Further exploration of the correlation between NLR and baseline variables was conducted using Pearson correlation and multivariate linear regression analysis. Results Among the total patients, SAP occurred in 60 (15%) patients. Multivariate analysis showed that NLR was significantly associated with SAP (NLR before IVT: aOR = 1.288; 95%CI = 1.123–1.476; p < 0.001; NLR after IVT (aOR = 1.113, 95%CI = 1.007–1.23; p = 0.036). The receiver operating characteristic curve showed that the predictive ability of NLR after IVT was better than NLR before IVT (area under the curve [AUC] of NLR after IVT: 0.80, 95%CI = 0.74–0.86; p < 0.001; NLR before IVT: 0.72, 95%CI = 0.66–0.80; p < 0.001), not only in predicting the occurrence of SAP but also in predicting short-term functional outcomes and one-year mortality. Furthermore, NLR after IVT was significantly correlated with the initial NIHSS score (p < 0.001) and early neurological outcomes after IVT (p < 0.001). Conclusions We demonstrated that increased NLR has a significant predictive effect on the occurrence of SAP and can be used to predict functional dependence and one-year mortality. NLR measured within 12–24 h after IVT had better predictive validity than that measured before IVT.