Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4–18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4–18] versus 6 [IQR, 3–14]), P=0.03; (odds ratio, 1.69 [95% CI, 1.08–2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2–6] versus 2 [IQR, 1–4], P<0.001) and death (odds ratio, 4.3 [95% CI, 2.22–8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.

中文翻译：

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COVID-19和急性缺血性卒中患者的特征和结果：全球COVID-19卒中注册中心。

最近的小病例病例系列暗示2019年冠状病毒病（COVID-19）与严重的大血管急性缺血性中风之间存在病理生理联系。鉴于严重中风通常与预后不良有关，并且可以通过再通气技术非常有效地治疗，因此，在一个具有代表性的大型患者队列中，迫切需要确认这种推定的关联，以警告中风临床医生，并告知院前和院内急性中风患者。途径。我们汇总了来自16个国家/地区的28个地点的所有住院患者，均接受了实验室确认的COVID-19和急性缺血性中风的住院治疗。为了评估COVID-19和非COVID-19患者在急性缺血性中风患者中的卒中严重性和预后（出院时或对仍住院的患者进行最新评估）是否不同，我们进行了1：1倾向评分在2003年至2019年之间对我们在急性卒中注册表中注册的COVID-19患者与非COVID-19患者进行的匹配分析和洛桑注册表分析。在2020年1月27日至2020年5月19日之间，有174名患者（中位年龄71.2岁） ； 37.9％的女性（患有COVID-19和急性缺血性中风）入院（每个部位中位数12名患者）。美国国立卫生研究院卒中量表的中位数为10（四分位间距[IQR]，4-18）。在336名COVID-19和非COVID-19患者的1：1匹配样本中，P = 0.03; （美国国立卫生研究院卒中量表分数较高的几率是1.69 [95％CI，1.08-2.65]）。有48例（27.6％）死亡，其中22例归因于COVID-19，而26例归因于中风。在可获得关于残疾状况信息的96名幸存者中，有49名（51％）出院时患有严重残疾。在倾向得分匹配的人群（n = 330）中，COVID-19患者的严重残疾风险更高（中位mRS 4 [IQR，2–6]与2 [IQR，1-4]，P <0.001）和与没有COVID-19的患者相比，死亡率（优势比为4.3 [95％CI，2.22-8.30]）。我们的研究结果表明，与非COVID-19缺血性中风相比，COVID-19相关性缺血性中风更为严重，功能预后差，死亡率更高。