ABSTRACT
Purpose: This study compared death and non-favorable discharge following a hospital admission for Coronavirus Disease 2019 (COVID-19) management for patients with a history of solid organ transplant (SOT) vs without (control). Methods: All non-pregnant adults who tested positive with symptomatic or asymptomatic COVID-19 and were admitted at a multihospital health-system from March 17, 2020 through August 24, 2020 were eligible for the study. Patients were excluded if their first positive COVID-19 test occurred >7 days before admission (potentially resolved) or >7 days after admission (potentially nosocomial). Patients not taking immunosuppression immediately prior to COVID-19 diagnosis were excluded from the SOT group. Outcomes included death at 60 days after admission and non-favorable discharge (death or hospice). To adjust for confounding due to differences in baseline demographics, a propensity score was calculated using age, sex, race, body mass index, hypertension, diabetes mellitus, chronic kidney disease, underlying liver disease, month of hospital admission, and area deprivation index (a surrogate for socioeconomic status). The matched cohort was generated using 1:1 nearest neighbor matching without replacement. Outcomes were analyzed using logistic regression that accounted for matching. Results: Among 4,562 included patients (108 SOT recipients and 4,454 controls), 60-day death occurred in 17% SOT vs 10% control (P=0.033) and non-favorable discharge in 18% SOT vs 9% control (P=0.004). Among 214 matched patients (107 SOT recipients, 107 controls), 60-day death occurred in 17% SOT vs 9% control (OR=2.0, 95%CI=0.9 to 4.4, P=0.106) and non-favorable discharge in 18% SOT vs 9% control (OR=2.1, 95%CI=1.0 to 4.6, P=0.063). As expected, propensity matching reduced confounding due to differences in baseline characteristics (Table 1). Transplanted organs included kidney (n=64), liver (n=13), lung (n=12), history of >1 organ (n=13), and heart (n=5). Conclusions: Recipients of SOT had a greater risk of 60-day death and non-favorable discharge among hospitalized patients with COVID-19 using unadjusted analysis. Preliminary data from the propensity matched analysis reported similar magnitudes of association but did not find statistical significance. A larger study may be needed to clarify whether immune-suppressed SOT recipients have greater risk of death or non-favorable discharge from COVID-19. (Table Presented) .
ABSTRACT
Background: COVID-19 has been shown to induce a hypercoagulable state thereby increasing the risk of arterial thrombosis resulting in Large Vessel Occlusion Stroke (LVOs) Objective: We performed a systematic review of published reports to study the clinical characteristics, and outcomes of COVID-19 acute ischemic stroke (AIS) patients with LVO treated with mechanical thrombectomy (MT) and compared them with historical controls. Methods: We conducted a systematic literature search from December 2019 to July 2020 using multiple combinations of keywords from PubMed and Ovid databases according to the PRISMA meta-analyses and systemic reviews guidelines and then pooled data from individual case series. We included studies where COVID -19 associated LVO cases were treated with MT and their clinical outcomes were reported. We then compared these findings with the historic patient data from the five landmark randomized MT trials, the Hermes collaborators (HC). Results: An initial search generated 12 studies but after excluding case reports and multiple reports comprising of the same series of patients, a total of five reports consisting of 51 patients were analyzed. The mean age of patients was 59 years (IQR 36-75), and 40 (78 %) were men. Median NIHSS on presentation was 20 (IQR 10-29). AIS with LVO was the presenting manifestation of COVID-19 in 16 (20%) of patients. Intracranial ICA was the most common site of occlusion found in 27 (53%) of patients with multi-territory occlusion in 10 (20 %). Final recanalization TICI ≥ 2b was achieved in 33 (64%) of patients but reocclusion was noted in 7 (14 %). Modified Rankin score (mRS) 0-2 was reported in 12 (23 %) of patients with 40 % in-hospital mortality. When compared to historic data from HC, COVID -19 patients were younger (59 vs 69 years), presented with a higher median NIHSS score (20 vs 17), and had a higher prevalence of ICA terminus occlusion (53% vs21% ). Similarly, patient outcomes were poor in the COVID -19 group with mRs 0-2 in (23 % versus46 %) and mortality (40 % vs 15 %) compared to Hermes group. Conclusion: COVID -19 AIS patients with LVO who underwent MT were younger, had multipleterritory occlusions with a propensity for ICA terminus location, and had poor angiographic andclinical outcomes as compared to historic data.
ABSTRACT
We present a radiology-pathology case series of 3 patients with coronavirus disease 2019 (COVID-19) with acute ischemic stroke due to fulminant carotid thrombosis overlying mild atherosclerotic plaque and propose a novel stroke mechanism: COVID-associated carotid atherothrombosis.