SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy

Abstract

Objective To 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. Methods In 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. Results Among 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. Conclusions Ischemic 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.

Neurovascular and infectious disease phenotype of acute stroke patients with and without COVID-19

“…In this study, we investigated the neurovascular and infectious disease characteristics of consecutive patients with acute stroke, with and without COVID-19 infection, admitted to a stroke hub during the first COVID wave in Lombardy, Italy, and their effect on in-hospital mortality and cause of death. The COVID + stroke population represented 2.5% of the total COVID-19 population and 22% of the total stroke population admitted to the San Gerardo Hospital in the study period, in agreement with previous studies conducted in areas hit hardest by the pandemic [ 19 , 20 ]. Our results showed that COVID + stroke patients did not differ from non-COVID ones in terms of pre-stroke status and neurovascular phenotype, even though an apparent excess of ischemic versus hemorrhagic stroke emerged (which was not statistically significant with our sample size).…”

Increased stroke severity and mortality in patients with SARS-CoV-2 infection: An analysis from the N3C database

“…The association of increased ischemic stroke severity and SARS-COV-2 infection has been observed in previous studies. 4 , 5 , 6 , 7 , 8 , 9 However, prior analyses were limited to the early period of the pandemic or by comparison to historical controls. Additionally, previous studies of HS and SARS-COV-2 infection have been mostly limited to small samples from single centers.…”

“… 1 , 2 , 3 Additionally, several studies found greater stroke severity in patients with ischemic stroke (IS) and concurrent SARS-CoV-2 infection. 4 , 5 , 6 , 7 , 8 , 9 Most of these data come from the early COVID-19 pandemic period when there was rapid and substantial disruption of stroke care delivery and resources. 10 , 11 , 12 , 13 , 14 , 15 Additionally, several observational studies investigating the effect of COVID-19 on ischemic stroke severity and recovery come from single center studies with relatively low sample sizes of SARS-CoV-2 positive patients.…”

“…10 , 11 , 12 , 13 , 14 , 15 Additionally, several observational studies investigating the effect of COVID-19 on ischemic stroke severity and recovery come from single center studies with relatively low sample sizes of SARS-CoV-2 positive patients. 1 , 7 , 8 This leads to limited generalizability and uncertainty of the magnitude of COVID-19’s effect on IS populations remains unclear. The same is true for hemorrhagic stroke (HS), which has even less published literature and smaller sample sizes.…”

SARS-CoV-2 y su relación con enfermedades isquémicas en adultos.

“…1634-1668 Journal Scientific MQRInvestigar 1653Fernández, López, & Ruano, 2021) señalan que el ictus isquémico puede ser una característica de presentación de la COVID-19, además de tener un mayor riesgo de mortalidad intrahospitalaria, lo mismo señalan Qureshi y col. (Qureshi, Abd-Allah, & Al-Senani, Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel, 2020) mencionando que el ictus isquémico como el hemorrágico pueden complicar el curso de la infección por la COVID-19. Pezzini y col (Pezzini, Grassi, & Group, 2022). indican que los accidentes cerebrovasculares isquémicos en pacientes con la COVID-19 tienen un perfil de factores de riesgo y una etiología distintivos, una mayor gravedad clínica y una mayor tasa de mortalidad intrahospitalaria en comparación con los pacientes sin la COVID-19.…”