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Comparative Study
. 2021 Jan 30;21(1):43.
doi: 10.1186/s12883-021-02075-1.

Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry

María E Ramos-Araque  1   2 , James E Siegler  3 , Marc Ribo  4   5 , Manuel Requena  4   5 , Cristina López  2 , Mercedes de Lera  2 , Juan F Arenillas  2 , Isabel Hernández Pérez  2 , Beatriz Gómez-Vicente  2 , Blanca Talavera  2 , Pere Cardona Portela  6 , Ana Nuñez Guillen  6 , Xabier Urra  7 , Laura Llull  7 , Arturo Renú  7 , Thanh N Nguyen  8 , Dinesh Jillella  9 , Fadi Nahab  9 , Raul Nogueira  10 , Diogo Haussen  10 , Ryna Then  11 , Jesse M Thon  11 , Luis Rodríguez Esparragoza  12 , Maria Hernández-Pérez  12 , Alejandro Bustamante  12 , Ossama Yassin Mansour  13 , Mohammed Megahed  14 , Tamer Hassan  15 , David S Liebeskind  16 , Ameer Hassan  17   18 , Saif Bushnaq  19 , Mohamed Osman  19 , Alejandro Rodriguez Vazquez  7 ; SVIN Multinational Registry and Task Force
Collaborators, Affiliations
Comparative Study

Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry

María E Ramos-Araque et al. BMC Neurol. .

Abstract

Background and purpose: Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology.

Methods: We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20-6/16/20).

Results: Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p</=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35-3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p = 0.01) were also independently predictive of mortality.

Conclusions: Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.

Keywords: COVID-19; Coronavirus; Cryptogenic; Mortality; Stroke.

PubMed Disclaimer

Conflict of interest statement

No competing financial interests exist for any of the authors or collaborators.

Figures

Fig. 1
Fig. 1
Mortality rate among patients with COVID-19 and stroke according to mortality score. One point was assigned for each clinical factor up to a total of 5 possible points: age 60 or more, male sex, NIHSS 10 or more, history of diabetes, and cryptogenic stroke
See this image and copyright information in PMC

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