Ischemic Stroke Occurs Less Frequently in Patients With COVID-19: A Multicenter Cross-Sectional Study.
Ischemic Stroke Occurs Less Frequently in Patients With COVID-19: A Multicenter Cross-Sectional Study.
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DOI：
10.1161/strokeaha.120.031217
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发表时间：
2020-12
期刊：
影响因子：
8.3
通讯作者：
MacKenzie TA
中科院分区：
文献类型：
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作者：
Bekelis K;Missios S;Ahmad J;Labropoulos N;Schirmer CM;Calnan DR;Skinner J;MacKenzie TA
补充数字内容可在文本中找到。2019冠状病毒病（COVID-19）对缺血性卒中发生的影响一直是越来越多猜测的主题，但尚未在大型观察性研究中得到证实。我们调查了COVID-19与中风之间的关系。我们进行了一项横断面研究，涉及2020年1月至4月从纽约州医疗保健系统出院的患者。采用混合效应logistic回归分析和倾向评分加权分析来控制混杂因素，并调查COVID-19与缺血性卒中的相关性。类似的技术被用于检测并发COVID-19感染对卒中患者不良结局的影响。24808例出院患者中，新冠肺炎确诊2513例（10.1%），急性缺血性脑卒中566例（0.2%）。与其他患者相比，被诊断为COVID-19的患者发生卒中的几率为1 / 4（优势比为0.25 [95% CI, 0.16-0.40]）。这种关联在所有年龄组中都是一致的。我们的结果在敏感性分析中是稳健的，包括倾向得分加权回归模型。在卒中患者中，同时感染严重急性呼吸综合征-冠状病毒2 （SARS-CoV-2）与较高的病死率相关（优势比，10.50 [95% CI, 3.54-31.18]），并有增加出院康复的趋势（优势比，2.45 [95% CI, 0.81-1.25]）。通过对来自纽约大型医疗保健系统的患者进行全面的横断面研究，我们没有发现缺血性卒中与COVID-19之间存在正相关。然而，与未感染COVID-19的中风患者相比，中风患者的预后更差，死亡率增加了9倍以上。虽然我们的观察性研究没有得出明确的结论，但我们的数据并不支持对COVID-19年轻成人卒中流行的担忧。
Supplemental Digital Content is available in the text. The impact of coronavirus disease 2019 (COVID-19) on the occurrence of ischemic stroke has been the subject of increased speculation but has not been confirmed in large observational studies. We investigated the association between COVID-19 and stroke. We performed a cross-sectional study involving patients discharged from a healthcare system in New York State, from January to April 2020. A mixed-effects logistic regression analysis and a propensity score–weighted analysis were used to control for confounders and investigate the association of COVID-19 with ischemic stroke. Similar techniques were used to detect the impact of concurrent COVID-19 infection on unfavorable outcomes for patients with stroke. Among 24 808 discharges, 2513 (10.1%) were diagnosed with COVID-19, and 566 (0.2%) presented with acute ischemic stroke. Patients diagnosed with COVID-19 were at one-quarter the odds of stroke compared with other patients (odds ratio, 0.25 [95% CI, 0.16–0.40]). This association was consistent in all age groups. Our results were robust in sensitivity analyses, including propensity score–weighted regression models. In patients presenting with stroke, concurrent infection with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was associated with higher case-fatality (odds ratio, 10.50 [95% CI, 3.54–31.18]) and a trend towards increased occurrence of discharge to rehabilitation (odds ratio, 2.45 [95% CI, 0.81–1.25]). Using a comprehensive cross-section of patients from a large NY-based healthcare system, we did not identify a positive association between ischemic stroke and COVID-19. However, patients with stroke with COVID-19 had worse outcomes compared with those without, with over a 9-fold increase in mortality. Although no definitive conclusions can be reached from our observational study, our data do not support the concerns for an epidemic of stroke in young adults with COVID-19.