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

Authors

James E. Siegler
Pere Cardona
Juan F. Arenillas
Blanca Talavera
Ana N. Guillen
Alba Chavarrıa-Miranda
Mercedes de Lera
Priyank Khandelwal
Ivo Bach
Ameer E. Hassan, The University of Texas Rio Grande Valley
Laurie Preston
Mary S. Patterson, The University of Texas Rio Grande Valley
Saif Bushnaq, The University of Texas Rio Grande Valley
Osama Zaidat, The University of Texas Rio Grande Valley

Document Type

Article

Publication Date

9-30-2020

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.

Comments

Original published version available at https://doi.org/10.1177%2F1747493020959216

Recommended Citation

Siegler, J. E., Cardona, P., Arenillas, J. F., Talavera, B., Guillen, A. N., Chavarría-Miranda, A., de Lera, M., Khandelwal, P., Bach, I., Patel, P., Singla, A., Requena, M., Ribo, M., Jillella, D. V., Rangaraju, S., Nogueira, R. G., Haussen, D. C., Vazquez, A. R., Urra, X., … Jovin, T. G. (2020). Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry. International Journal of Stroke. https://doi.org/10.1177/1747493020959216

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Publication Title

International Journal of Stroke

DOI

10.1177/1747493020959216

Academic Level

faculty

Mentor/PI Department

Neurology