Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States.
Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States.
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105535
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Majersik JJ
中科院分区：
文献类型：
--
作者：
de Havenon A;Ney JP;Callaghan B;Delic A;Hohmann S;Shippey E;Esper GJ;Stulberg E;Tirschwell D;Frontera J;Yaghi S;Anadani M;Majersik JJ
研究表明，同时患有缺血性中风 (IS) 和 2019 年冠状病毒病 (COVID-19) 的患者预后较差，但样本量较小。我们回顾性地确定了 Vizient Clinical Data Base® 中出院诊断为 IS 的患者。研究结果是院内死亡和顺利出院（回家或急性康复）。在初步分析中，我们将 2020 年 4 月 1 日至 7 月 31 日出院的经实验室确诊的 COVID-19 (IS-COVID) IS 患者与 2019 年出院的 COVID 前 IS 患者（IS 对照）进行了比较。在二次分析中，我们将一组匹配的 IS-COVID 患者与 IS 对照中患有肺炎的患者 (IS-PNA) 进行了比较，这些患者是通过逆概率加权 (IPW) 创建的。在初步分析中，我们纳入了来自 46 个州 312 家医院的 166,586 名 IS 对照者和 2086 名 IS-COVID 患者。与 IS 对照相比，IS-COVID 患者患高血压、血脂异常或吸烟的可能性较小，但男性、年轻患者、糖尿病、肥胖、急性肾衰竭、急性冠状动脉综合征、静脉血栓栓塞、插管以及合并脑内或蛛网膜下腔出血的可能性更大（均 p<0.05）。黑人和西班牙裔患者分别占 IS 对照的 21.7% 和 7.4%，但占 IS-COVID 的 33.7% 和 18.5% (p<0.001)。与 IS 对照相比，IS-COVID 患者接受阿替普酶治疗（1.8% vs. 5.6%，p<0.001）、机械血栓切除术（4.4% vs. 6.7%，p<0.001）、顺利出院（33.9% vs. 66.4%，p<0.001）的可能性较小，但死亡的可能性更大（30.4% vs. 6.5%，p<0.001）。 p<0.001）。在 IS-COVID 和 IS-PNA 患者的匹配队列中，IS-COVID 的死亡风险较高（IPW 加权 OR 1.56，95% CI 1.33-1.82），顺利出院的几率较低（IPW 加权 OR 0.63，95% CI 0.54-0.73）。患有 COVID-19 的缺血性中风患者更有可能是男性、年轻人、黑人或西班牙裔，与 2019 年以来的缺血性中风对照以及缺血性中风和肺炎患者相比，发病率和死亡率显着增加。
Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes. We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW). In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p<0.05). Black and Hispanic patients accounted for 21.7% and 7.4% of IS controls, respectively, but 33.7% and 18.5% of IS-COVID (p<0.001). IS-COVID, versus IS controls, were less likely to receive alteplase (1.8% vs 5.6%, p<0.001), mechanical thrombectomy (4.4% vs. 6.7%, p<0.001), to have favorable discharge (33.9% vs. 66.4%, p<0.001), but more likely to die (30.4% vs. 6.5%, p<0.001). In the matched cohort of patients with IS-COVID and IS-PNA, IS-COVID had a higher risk of death (IPW-weighted OR 1.56, 95% CI 1.33-1.82) and lower odds of favorable discharge (IPW-weighted OR 0.63, 95% CI 0.54-0.73). Ischemic stroke patients with COVID-19 are more likely to be male, younger, and Black or Hispanic, with significant increases in morbidity and mortality compared to both ischemic stroke controls from 2019 and to patients with ischemic stroke and pneumonia.
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