Importance: Case series without control groups suggest that Covid-19 may cause ischemic stroke, but whether Covid-19 is associated with a higher risk of ischemic stroke than would be expected from a viral respiratory infection is uncertain. Objective: To compare the rate of ischemic stroke between patients with Covid-19 and patients with influenza, a respiratory viral illness previously linked to stroke. Design: A retrospective cohort study. Setting: Two academic hospitals in New York City. Participants: We included adult patients with emergency department visits or hospitalizations with Covid-19 from March 4, 2020 through May 2, 2020. Our comparison cohort included adult patients with emergency department visits or hospitalizations with influenza A or B from January 1, 2016 through May 31, 2018 (calendar years spanning moderate and severe influenza seasons). Exposures: Covid-19 infection confirmed by evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the nasopharynx by polymerase chain reaction, and laboratory-confirmed influenza A or B. Main Outcomes and Measures: A panel of neurologists adjudicated the primary outcome of acute ischemic stroke and its clinical characteristics, etiological mechanisms, and outcomes. We used logistic regression to compare the proportion of Covid-19 patients with ischemic stroke versus the proportion among patients with influenza. Results: Among 2,132 patients with emergency department visits or hospitalizations with Covid-19, 31 patients (1.5%; 95% confidence interval [CI], 1.0%-2.1%) had an acute ischemic stroke. The median age of patients with stroke was 69 years (interquartile range, 66-78) and 58% were men. Stroke was the reason for hospital presentation in 8 (26%) cases. For our comparison cohort, we identified 1,516 patients with influenza, of whom 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 significantly higher with Covid-19 than with influenza infection (odds ratio, 7.5; 95% CI, 2.3-24.9). Conclusions and Relevance: Approximately 1.5% of patients with emergency department visits or hospitalizations with Covid-19 experienced ischemic stroke, a rate 7.5-fold higher than in patients with influenza. Future studies should investigate the thrombotic mechanisms in Covid-19 in order to determine optimal strategies to prevent disabling complications like ischemic stroke.

中文翻译：

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Covid-19 患者与流感患者的缺血性卒中风险。

重要性：没有对照组的病例系列表明 Covid-19 可能导致缺血性中风，但 Covid-19 是否与比病毒性呼吸道感染预期更高的缺血性中风风险相关尚不确定。目的：比较 Covid-19 患者和流感患者的缺血性卒中发生率，流感是一种以前与中风相关的呼吸道病毒性疾病。设计：回顾性队列研究。地点：纽约市的两家学术医院。参与者：我们纳入了从 2020 年 3 月 4 日至 2020 年 5 月 2 日因 Covid-19 就诊或住院的成年患者。我们的比较队列包括从 2016 年 1 月 1 日至 2016 年因甲型或乙型流感就诊或住院的成年患者5月31日，2018 年（跨越中度和重度流感季节的日历年）。暴露：通过聚合酶链反应证实鼻咽部存在严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的证据证实了 Covid-19 感染，以及实验室证实的甲型或乙型流感。主要结果和措施：一组神经学家裁定急性缺血性卒中的主要结局及其临床特征、病因机制和结局。我们使用逻辑回归来比较 Covid-19 缺血性卒中患者的比例与流感患者的比例。结果：在 2,132 名因 Covid-19 就诊或住院的患者中，31 名患者（1.5%；95% 置信区间 [CI]，1.0%-2.1%）患有急性缺血性卒中。中风患者的中位年龄为 69 岁（四分位距为 66-78），其中 58% 为男性。中风是 8 例（26%）病例住院的原因。对于我们的比较队列，我们​​确定了 1,516 名流感患者，其中 0.2%（95% CI，0.0-0.6%）患有急性缺血性卒中。在对年龄、性别和种族进行调整后，Covid-19 患者发生卒中的可能性显着高于流感感染患者（优势比，7.5；95% CI，2.3-24.9）。结论和相关性：在急诊科就诊或住院的 Covid-19 患者中，约有 1.5% 发生缺血性卒中，这一比例是流感患者的 7.5 倍。未来的研究应调查 Covid-19 中的血栓形成机制，以确定预防缺血性中风等致残并发症的最佳策略。