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Stroke ; 52(11): e706-e709, 2021 11.
Article in English | MEDLINE | ID: covidwho-1371922
Neurology ; 96(11): e1527-e1538, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1028513


OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality. METHODS: A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death. RESULTS: A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04-1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age- and severity-matched controls. CONCLUSIONS: The incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.

COVID-19/mortality , Confusion/physiopathology , Consciousness Disorders/physiopathology , Hospital Mortality , Stroke/physiopathology , Aged , Aged, 80 and over , Ageusia/epidemiology , Ageusia/physiopathology , Anosmia/epidemiology , Anosmia/physiopathology , Ataxia/epidemiology , Ataxia/physiopathology , COVID-19/physiopathology , Confusion/epidemiology , Consciousness Disorders/epidemiology , Cranial Nerve Diseases/epidemiology , Cranial Nerve Diseases/physiopathology , Delirium/epidemiology , Delirium/physiopathology , Female , Headache/epidemiology , Headache/physiopathology , Humans , Male , Middle Aged , Paresthesia/epidemiology , Paresthesia/physiopathology , Primary Dysautonomias/epidemiology , Primary Dysautonomias/physiopathology , Recurrence , SARS-CoV-2 , Seizures/epidemiology , Seizures/physiopathology , Stroke/epidemiology , Vertigo/epidemiology , Vertigo/physiopathology
Interv Neuroradiol ; 26(5): 623-628, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-736342


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.

Arterial Occlusive Diseases/mortality , Coronavirus Infections/complications , Coronavirus Infections/mortality , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Adult , Aged , Aged, 80 and over , COVID-19 , Cohort Studies , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/analysis , Hospital Mortality , Humans , Lung Diseases/etiology , Lung Diseases/mortality , Male , Middle Aged , Pandemics , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Risk Factors , Smoking/mortality , Stroke/etiology , Stroke/mortality , Treatment Outcome