Background

An increased rate of thrombotic events has been associated to Coronavirus Disease 19 (COVID-19) with a variable rate of acute stroke. Our aim is to uncover the rate of acute stroke in COVID-19 patients and identify those cases in which a possible causative relationship could exist.

Methods

We performed a single-center analysis of a prospective mandatory database. We studied all patients with confirmed COVID-19 and stroke diagnoses from March 2^nd to April 30^th. Demographic, clinical, and imaging data were prospectively collected. Final diagnosis was determined after full diagnostic work-up unless impossible due to death.

Results

Of 2050 patients with confirmed SARS-CoV-2 infection, 21 (1.02%) presented an acute ischemic stroke 21 and 4 (0.2%) suffered an intracranial hemorrhage. After the diagnostic work-up, in 60.0% ischemic and all hemorrhagic strokes patients an etiology non-related with COVID-19 was identified. Only in 6 patients the stroke cause was considered possibly related to COVID-19, all of them required mechanical ventilation before stroke onset. Ten patients underwent endovascular treatment; compared with patients who underwent EVT in the same period, COVID-19 was an independent predictor of in-hospital mortality (50% versus 15%; Odds Ratio, 6.67; 95% CI, 1.1-40.4; p 0.04).

Conclusions

The presence of acute stroke in patients with COVID-19 was below 2% and most of them previously presented established stroke risk factors. Without other potential cause, stroke was an uncommon complication and exclusive of patients with a severe pulmonary injury. The presence of COVID-19 in patients who underwent EVT was an independent predictor of in-hospital mortality.

中文翻译：

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COVID-19和中风：高容量中心的发病率和病因学描述

背景

冠状病毒疾病19（COVID-19）与急性卒中的发生率可变有关，导致血栓形成事件的发生率增加。我们的目的是揭示COVID-19患者的急性中风发生率，并确定可能存在因果关系的病例。

方法

我们对预期的强制性数据库进行了单中心分析。我们研究了所有患者确诊COVID-19和中风的诊断，从3月2日^第二至4月30^日。前瞻性地收集了人口，临床和影像数据。最终诊断是经过充分的诊断检查后确定的，除非因死亡而无法诊断。

结果

在确认患有SARS-CoV-2感染的2050名患者中，有21名（1.02％）出现了急性缺血性中风21，有4名（0.2％）出现了颅内出血。诊断检查后，在60.0％的缺血性和所有出血性中风患者中，发现了与COVID-19不相关的病因。仅在6例患者中，卒中原因被认为可能与COVID-19有关，所有患者在卒中发作前都需要进行机械通气。十名患者接受了血管内治疗；与同期接受EVT的患者相比，COVID-19是住院死亡率的独立预测指标（50％比15％；几率为6.67； 95％CI为1.1-40.4； P = 0.04）。

结论

COVID-19患者中的急性中风的发生率低于2％，并且其中大多数以前已证明存在中风危险因素。没有其他潜在原因，中风是一种罕见的并发症，不包括严重肺损伤的患者。接受EVT的患者中COVID-19的存在是院内死亡率的独立预测因子。