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. 2020 Oct;26(5):623-628.
doi: 10.1177/1591019920954603. Epub 2020 Aug 30.

Predictors of mortality for patients with COVID-19 and large vessel occlusion

David J Altschul  1 , Charles Esenwa  2 , Neil Haranhalli  1 , Santiago R Unda  1 , Rafael de La Garza Ramos  1 , Joseph Dardick  3 , Jenelys Fernandez-Torres  1 , Aureliana Toma  1 , Daniel Labovitz  4 , Natalie Cheng  4 , Seon-Kyu Lee  4 , Allan Brook  4 , Richard Zampolin  4
Affiliations

Predictors of mortality for patients with COVID-19 and large vessel occlusion

David J Altschul et al. Interv Neuroradiol. 2020 Oct.

Abstract

Background: This study evaluates the mortality risk of patients with emergent large vessel occlusion (ELVO) and COVID-19 during the pandemic.

Methods: We performed a retrospective cohort study of two cohorts of consecutive patients with ELVO admitted to a quaternary hospital from March 1 to April 17, 2020. We abstracted data from electronic health records on baseline, biomarker profiles, key time points, quality measures and radiographic data.

Results: Of 179 patients admitted with ischemic stroke, 36 had ELVO. Patients with COVID-19 and ELVO had a higher risk of mortality during the pandemic versus patients without COVID-19 (OR 16.63, p = 0.004). An age-based sub-analysis showed in-hospital mortality in 60% of COVID-19 positive patients between 61-70 years-old, 66.7% in between 51-60 years-old, 50% in between 41-50 years-old and 33.3% in between 31-40 years old. Patients that presented with pulmonary symptoms at time of stroke presentation had 71.4% mortality rate. 27.3% of COVID-19 patients presenting with ELVO had a good outcome at discharge (mRS 0-2). Patients with a history of cigarette smoking (p = 0.003), elevated d-dimer (p = 0.007), failure to recanalize (p = 0.007), and elevated ferritin levels (p = 0.006) had an increased risk of mortality.

Conclusion: Patients with COVID-19 and ELVO had a significantly higher risk for mortality compared to COVID-19 negative patients with ELVO. A small percentage of COVID-19 ELVO patients had good outcomes. Age greater than 60 and pulmonary symptoms at presentation have higher risk for mortality. Other risk factors for mortality were a history of cigarette smoking, elevated, failure to recanalize, elevated d-dimer and ferritin levels.

Keywords: COVID-19; Ischemic stroke; emergent large vessel occlusion; mechanical thrombectomy; outcomes.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) Age breakdown for in-hospital mortality in patients tested positive for COVID-19 and (b) in patients with COVID-19 pulmonary symptoms on presentation.
See this image and copyright information in PMC

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