Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Neurological Sciences
Published in: Neurological Sciences 8/2022

Open Access 23-05-2022 | Stroke | COVID-19

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

Authors: Simone Beretta, Francesca Iannuzzi, Susanna Diamanti, Elisa Bianchi, Luca D’Urbano, Colella Elisa, Alban Rugova, Carlo Morotti Colleoni, Ettore Beghi, Paolo Bonfanti, Carlo Ferrarese

Published in: Neurological Sciences | Issue 8/2022

Login to get access

Abstract

Background

The infectious disease phenotype of acute stroke associated with COVID-19 has been poorly characterized.

Objective

We investigated the neurovascular and infectious disease phenotype of stroke patients with and without COVID-19 infection, and their effect on in-hospital mortality.

Methods

This is a retrospective cohort study of consecutive patients with acute stroke, admitted to any ward of a hub hospital for stroke in Lombardy, Italy, during the first wave of COVID-19. Demographic, neurovascular, infectious disease, and respiratory characteristics were collected. The effect of clinical variables on survival was evaluated using logistic regression models.

Results

One hundred thirty-seven patients with acute stroke were recruited; 30 (21.9%) patients had COVID-19 and represented 2.5% of the 1218 COVID-19 patients hospitalized in the study period. Demographics, comorbidities, stroke type, stroke severity, and etiology did not differ between COVID + stroke patients and non-COVID stroke patients, except for an excess of multi-embolic ischemic stroke in the COVID + group. Most COVID + stroke patients had symptomatic infection (60%) and interstitial pneumonia (70%). COVID + stroke patients required more frequently respiratory support (77% versus 29%; p < 0.0001) and had higher in-hospital mortality (40% versus 12%; p = 0.0005) than non-COVID stroke patients. Mortality was independently associated with symptomatic interstitial pneumonia (aOR 6.7; 95% CI 2.0–22.5; p = 0.002) and, to a lesser extent, with NIHSS on admission (aOR 1.1; 95% CI 1.03–1.2; p = 0.007) and recanalization therapies (aOR 0.2; 95% CI 0.04–0.98; p = 0.046).

Conclusion

Symptomatic interstitial pneumonia was the major driver of in-hospital mortality in COVID + stroke patients.
Appendix
Available only for authorised users
Literature
1.
Connors JM, Levy JH (2020) COVID-19 and its implications for thrombosis and anticoagulation. Blood 135:2033–2040CrossRef
2.
Sagris D, Papanikolaou A, Kvernland A, Korompoki E, Frontera JA, Troxel AB et al (2021) COVID-19 and ischemic stroke. Eur J Neurol 28:3826–3836CrossRef
3.
Stein LK, Mayman NA, Dhamoon MS, Fifi JT (2021) The emerging association between COVID-19 and acute stroke. Trends Neurosci 44:527–537CrossRef
4.
Uchino K, Kolikonda MK, Brown D, Kovi S, Collins D, Khawaja Z et al (2020) Decline in stroke presentations during COVID-19 surge. Stroke 51:2544–2547CrossRef
5.
Sacco S, Ricci S, Ornello R, Eusebi P, Petraglia L, Toni D (2020) Reduced admissions for cerebrovascular events during COVID-19 outbreak in Italy. Stroke 51:3746–3750CrossRef
6.
Katsanos AH, Palaiodimou L, Zand R, Yaghi S, Kamel H, Navi BB et al (2021) The impact of SARS-CoV-2 on stroke epidemiology and care: a meta-analysis. Ann Neurol 89:380–388CrossRef
7.
Nannoni S, de Groot R, Bell S, Markus HS (2021) Stroke in COVID-19: a systematic review and meta-analysis. Int J Stroke 16:137–149CrossRef
8.
Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J et al (2020) Characteristics and outcomes in patients with COVID-19 and acute ischemic stroke: the global COVID-19 stroke registry. Stroke 51:e254-258CrossRef
9.
Siegler JE, Cardona P, Arenillas JF, Talavera B, Guillen AN, Chavarría-Miranda A et al (2021) Cerebrovascular events and outcomes in hospitalized patients with COVID-19: the SVIN COVID-19 multinational registry. Int J Stroke 16:437–447CrossRef
10.
Khandelwal P, Al-Mufti F, Tiwari A, Singla A, Dmytriw AA, Piano M et al (2021) Incidence, characteristics and outcomes of large vessel stroke in COVID-19 cohort: an international multicenter study. Neurosurgery 89:E35-41CrossRef
11.
12.
Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Johnston SC (2009) Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke 40:2276–2293CrossRef
13.
de Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 56:221–229CrossRef
14.
Siepmann T, Sedghi A, Simon E, Winzer S, Barlinn J, de With K et al (2021) Increased risk of acute stroke among patients with severe COVID-19: a multicenter study and meta-analysis. Eur J Neurol 28:238–247CrossRef
15.
Bekelis K, Missios S, Ahmad J, Labropoulos N, Schirmer CM, Calnan DR et al (2020) Ischemic stroke occurs less frequently in patients with COVID-19: a multicenter cross-sectional study. Stroke 51:3570–3576CrossRef
16.
Tan YK, Goh C, Leow AST, Tambyah PA, Ang A, Yap ES et al (2020) COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis 50:587–595CrossRef
17.
Dmytriw AA, Dibas M, Schirmer CM, Settecase F, Heran MKS, Efendizade A et al (2021) North American Neurovascular COVID-19 (NAN-C) Consortium. Age and acute ischemic stroke outcome in North American patients with COVID-19. J Am Heart Assoc 10(14):e021046CrossRef
18.
Delgado-Rodríguez M, Llorca J (2004) Bias J Epidemiol Community Health 58:635–641CrossRef
19.
Merkler AE, Parikh NS, Mir S, Gupta A, Kamel H, Lin E et al (2020) Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza. JAMA Neurol 77:1–7CrossRef
20.
Pezzini A, Grassi M, Silvestrelli G, Locatelli M, Rifino N, Beretta S et al (2021) SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy. J Neurol 24:1–11
21.
Frisullo G, Scala I, Bellavia S, Broccolini A, Brunetti V, Morosetti R et al (2021) COVID-19 and stroke: from the cases to the causes. Rev Neurosci 32:659–669CrossRef
22.
Fridman S, Bres Bullrich M, Jimenez-Ruiz A, Costantini P, Shah P, Just C et al (2020) Stroke risk, phenotypes, and death in COVID-19: systematic review and newly reported cases. Neurology 95:e3373-3385CrossRef
23.
Brusasco C, Corradi F, Di Domenico A, Raggi F, Timossi G, Santori G et al (2021) Continuous positive airway pressure in COVID-19 patients with moderate-to-severe respiratory failure. Eur Respir J 57:2002524CrossRef
24.
Weimar C, Ziegler A, König IR, Diener HC (2002) Predicting functional outcome and survival after acute ischemic stroke. J Neurol 249:888–8895CrossRef
25.
Katsanos AH, Malhotra K, Goyal N, Palaiodimou L, Schellinger PD, Caso V et al (2019) Mortality risk in acute ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy. J Am Heart Assoc 8:e014425CrossRef
26.
Karamchandani RR, Rhoten JB, Strong D, Chang B, Asimos AW (2021) Mortality after large artery occlusion acute ischemic stroke. Sci Rep 11:10033CrossRef
Metadata
Title
Neurovascular and infectious disease phenotype of acute stroke patients with and without COVID-19
Authors
Simone Beretta
Francesca Iannuzzi
Susanna Diamanti
Elisa Bianchi
Luca D’Urbano
Colella Elisa
Alban Rugova
Carlo Morotti Colleoni
Ettore Beghi
Paolo Bonfanti
Carlo Ferrarese
Publication date
23-05-2022
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 8/2022
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-022-06133-5

Other articles of this Issue 8/2022

Neurological Sciences 8/2022 Go to the issue

Brief Communication

Beyond canvas: behavioral onset of rfc1-expansion disease in an Italian family—causal or casual?

Original Article

Risk factors for motor complications in female patients with Parkinson’s disease

History of Neurology

Vincenzo Neri (1880–1960) and his sign to detect leg weakness due to corticospinal tract injury

Letter to the Editor

Marked response to levodopa in a patient with multiple system atrophy presenting with orthostatic hypotension: should reduced DAT uptake on DaTSCAN be a criterion for response to levodopa?

COVID-19

COVID-19-associated severe mono-hemispheric encephalitis in a young infant

Original Article

Adult-onset autosomal dominant leukodystrophy and neuronal intranuclear inclusion disease: lessons from two new Chinese families