ABSTRACT
[Figure: see text].
Subject(s)
COVID-19/metabolism , Inflammation/metabolism , Ischemic Stroke/metabolism , Thrombophilia/metabolism , Aged , Aged, 80 and over , Blood Sedimentation , C-Reactive Protein/metabolism , COVID-19/complications , Cluster Analysis , Female , Ferritins/metabolism , Fibrin Fibrinogen Degradation Products/metabolism , Fibrinogen/metabolism , Hospital Mortality , Humans , Interleukin-6/metabolism , Ischemic Stroke/complications , L-Lactate Dehydrogenase/metabolism , Leukocyte Count , Logistic Models , Machine Learning , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/metabolism , Partial Thromboplastin Time , Pulmonary Embolism/complications , Pulmonary Embolism/metabolism , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Venous Thrombosis/complications , Venous Thrombosis/metabolismABSTRACT
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.