Objectives

Multiple prior studies have shown a relationship between COVID-19 and strokes; further, COVID-19 has been shown to influence both time-to-thrombectomy and overall thrombectomy rates. Using large-scale, recently released national data, we assessed the association between COVID-19 diagnosis and patient outcomes following mechanical thrombectomy.

Materials and methods

Patients in this study were identified from the 2020 National Inpatient Sample. All patients with arterial strokes undergoing mechanical thrombectomy were identified using ICD-10 coding criteria. Patients were further stratified by COVID diagnosis (positive vs. negative). Other covariates, including patient/hospital demographics, disease severity, and comorbidities were collected. Multivariable analysis was used to determine the independent effect of COVID-19 on in-hospital mortality and unfavorable discharge.

Results

5078 patients were identified in this study; 166 (3.3%) were COVID-19 positive. COVID-19 patients had a significantly higher mortality rate (30.1% vs. 12.4%, p < 0.001). When controlling for patient/hospital characteristics, APR-DRG disease severity, and Elixhauser Comorbidity Index, COVID-19 was an independent predictor of increased mortality (OR 1.13, p = 0.002). COVID-19 was not significantly related to discharge disposition (p = 0.480). Older age and increased APR-DRG disease severity were also correlated with increase morality.

Conclusions

Overall, this study indicates that COVID-19 is a predictor of mortality among mechanical thrombectomy. This finding is likely multifactorial but may be related to multisystem inflammation, hypercoagulability, and re-occlusion seen in COVID-19 patients. Further research would be needed to clarify these relationships.

中文翻译：

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COVID-19 患者缺血性卒中机械取栓后的死亡率

目标

先前的多项研究已表明 COVID-19 与中风之间存在关联；此外，COVID-19 已被证明会影响血栓切除时间和总体血栓切除率。利用最近发布的大规模国家数据，我们评估了 COVID-19 诊断与机械血栓切除术后患者预后之间的关联。

材料和方法

本研究中的患者是从 2020 年全国住院患者样本中确定的。所有接受机械血栓切除术的动脉卒中患者均使用 ICD-10 编码标准进行识别。根据新冠肺炎诊断（阳性与阴性）对患者进行进一步分层。收集其他协变量，包括患者/医院人口统计、疾病严重程度和合并症。使用多变量分析来确定 COVID-19 对院内死亡率和不良出院的独立影响。

结果

本研究共确定了 5078 名患者；166 人 (3.3%) 的 COVID-19 呈阳性。COVID-19 患者的死亡率显着较高（30.1% vs. 12.4%，p < 0.001）。当控制患者/医院特征、APR-DRG 疾病严重程度和 Elixhauser 合并症指数时，COVID-19 是死亡率增加的独立预测因子（OR 1.13，p = 0.002）。COVID-19 与出院处置没有显着相关 (p = 0.480)。年龄较大和 APR-DRG 疾病严重程度的增加也与道德水平的提高相关。

结论

总体而言，这项研究表明，COVID-19 是机械血栓切除术死亡率的预测因子。这一发现可能是多因素的，但可能与 COVID-19 患者中出现的多系统炎症、高凝状态和再闭塞有关。需要进一步的研究来澄清这些关系。