Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza
Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza
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DOI：
10.1001/jamaneurol.2020.2730
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发表时间：
2020-11-01
期刊：
影响因子：
29
通讯作者：
Navi, Babak B.
中科院分区：
文献类型：
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作者：
Merkler, Alexander E.;Parikh, Neal S.;Navi, Babak B.
重要性 目前尚不清楚 2019 年冠状病毒病 (COVID-19) 是否与缺血性中风的风险高于病毒性呼吸道感染的预期风险相关。目的 比较 COVID-19 患者和流感患者（一种先前与中风相关的呼吸道病毒性疾病）患者的缺血性中风发生率。设计、设置和参与者 这项回顾性队列研究在纽约州纽约市的 2 家学术医院进行，纳入了 2020 年 3 月 4 日至 2020 年 5 月 2 日因 COVID-19 急诊就诊或住院的成人患者。比较队列包括 2016 年 1 月 1 日至 2018 年 5 月 31 日因 A/B 型流感急诊就诊或住院的成人（涵盖中度和重度流感）季节）。通过聚合酶链反应和实验室确诊的甲型/乙型流感，鼻咽部存在严重急性呼吸综合征冠状病毒 2 证据证实暴露于 COVID-19 感染。主要结果和措施 神经科医生小组裁定了急性缺血性卒中的主要结果及其临床特征、机制和结果。我们使用逻辑回归来比较患有缺血性中风的 COVID-19 患者的比例与患有流感的患者的比例。结果 在 1916 名因 COVID-19 急诊就诊或住院的患者中，31 名（1.6%；95% CI，1.1%-2.3%）患有急性缺血性卒中。脑卒中患者的中位年龄为 69 岁（四分位数范围，66-78 岁）； 18 名 (58%) 是男性。 8 例 (26%) 患者因中风入院。相比之下，1486 名流感患者中有 3 名（0.2%；95% CI，0.0%-0.6%）患有急性缺血性中风。调整年龄、性别和种族后，感染 COVID-19 的中风可能性高于感染流感（比值比，7.6；95% CI，2.3-25.2）。在调整血管危险因素、病毒症状学和重症监护病房入院的敏感性分析中，这种关联仍然存在。结论和相关性 在这项来自纽约市 2 家学术医院的回顾性队列研究中，前往急诊室或住院的 COVID-19 成人患者中约有 1.6% 经历过缺血性中风，与流感患者队列相比，中风的发生率更高。需要进行更多研究来证实这些发现，并调查与 COVID-19 相关的可能的血栓形成机制。这项队列研究比较了纽约州纽约市 2 家医院的 COVID-19 患者与流感患者的缺血性中风发生率。问题 2019 年冠状病毒病 (COVID-19) 患者与流感（一种先前与中风相关的呼吸道病毒）患者之间的急性缺血性中风风险如何比较？结果 在这项队列研究中，与 1486 名因流感就诊或住院的患者相比，1916 名因 COVID-19 就诊或住院的患者发生缺血性中风的风险较高。意味着与流感患者相比，COVID-19 患者发生急性缺血性中风的风险似乎更高。
Importance It is uncertain whether coronavirus disease 2019 (COVID-19) is associated with a higher risk of ischemic stroke than would be expected from a viral respiratory infection. Objective To compare the rate of ischemic stroke between patients with COVID-19 and patients with influenza, a respiratory viral illness previously associated with stroke. Design, Setting, and Participants This retrospective cohort study was conducted at 2 academic hospitals in New York City, New York, and included adult patients with emergency department visits or hospitalizations with COVID-19 from March 4, 2020, through May 2, 2020. The comparison cohort included adults with emergency department visits or hospitalizations with influenza A/B from January 1, 2016, through May 31, 2018 (spanning moderate and severe influenza seasons). Exposures COVID-19 infection confirmed by evidence of severe acute respiratory syndrome coronavirus 2 in the nasopharynx by polymerase chain reaction and laboratory-confirmed influenza A/B. Main Outcomes and Measures A panel of neurologists adjudicated the primary outcome of acute ischemic stroke and its clinical characteristics, mechanisms, and outcomes. We used logistic regression to compare the proportion of patients with COVID-19 with ischemic stroke vs the proportion among patients with influenza. Results Among 1916 patients with emergency department visits or hospitalizations with COVID-19, 31 (1.6%; 95% CI, 1.1%-2.3%) had an acute ischemic stroke. The median age of patients with stroke was 69 years (interquartile range, 66-78 years); 18 (58%) were men. Stroke was the reason for hospital presentation in 8 cases (26%). In comparison, 3 of 1486 patients with influenza (0.2%; 95% CI, 0.0%-0.6%) had an acute ischemic stroke. After adjustment for age, sex, and race, the likelihood of stroke was higher with COVID-19 infection than with influenza infection (odds ratio, 7.6; 95% CI, 2.3-25.2). The association persisted across sensitivity analyses adjusting for vascular risk factors, viral symptomatology, and intensive care unit admission. Conclusions and Relevance In this retrospective cohort study from 2 New York City academic hospitals, approximately 1.6% of adults with COVID-19 who visited the emergency department or were hospitalized experienced ischemic stroke, a higher rate of stroke compared with a cohort of patients with influenza. Additional studies are needed to confirm these findings and to investigate possible thrombotic mechanisms associated with COVID-19.This cohort study compares the rate of ischemic stroke among patients with COVID-19 vs patients with influenza in 2 hospitals in New York City, New York.Question How does the risk of acute ischemic stroke compare between patients with coronavirus disease 2019 (COVID-19) and patients with influenza, a respiratory virus previously associated with stroke? Findings In this cohort study, 1916 patients with emergency department visits or hospitalizations with COVID-19 had an elevated risk of ischemic stroke compared with 1486 patients with emergency department visits or hospitalizations with influenza. Meaning Patients with COVID-19 appear to have a heightened risk of acute ischemic stroke compared with patients with influenza.