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Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study.
Peng, Teng J; Jasne, Adam S; Simonov, Michael; Abdelhakim, Safa; Kone, Gbambele; Cheng, Yee Kuang; Rethana, Melissa; Tarasaria, Karan; Herman, Alison L; Baker, Anna D; Yaghi, Shadi; Frontera, Jennifer A; Sansing, Lauren H; Falcone, Guido J; Spudich, Serena; Schindler, Joseph; Sheth, Kevin N; Sharma, Richa.
  • Peng TJ; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Jasne AS; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Simonov M; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States.
  • Abdelhakim S; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Kone G; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Cheng YK; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Rethana M; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Tarasaria K; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Herman AL; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Baker AD; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Yaghi S; Department of Neurology, New York University Langone Health, New York, NY, United States.
  • Frontera JA; Department of Neurology, Brown University School of Medicine, Providence, RI, United States.
  • Sansing LH; Department of Neurology, New York University Langone Health, New York, NY, United States.
  • Falcone GJ; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Spudich S; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Schindler J; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Sheth KN; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
  • Sharma R; Department of Neurology, Yale University School of Medicine, New Haven, CT, United States.
Front Neurol ; 12: 741044, 2021.
Article in English | MEDLINE | ID: covidwho-1477845
ABSTRACT

Objectives:

Our objective was to identify characteristics associated with having an acute ischemic stroke (AIS) among hospitalized COVID-19 patients and the subset of these patients with a neurologic symptom. Materials and

Methods:

Our derivation cohort consisted of COVID-19 patients admitted to Yale-New Haven Health between January 3, 2020 and August 28, 2020 with and without AIS. We also studied a sub-cohort of hospitalized COVID-19 patients demonstrating a neurologic symptom with and without an AIS. Demographic, clinical, and laboratory results were compared between AIS and non-AIS patients in the full COVID-19 cohort and in the sub-cohort of COVID-19 patients with a neurologic symptom. Multivariable logistic regression models were built to predict ischemic stroke risk in these two COVID-19 cohorts. These 2 models were externally validated in COVID-19 patients hospitalized at a major health system in New York. We then compared the distribution of the resulting predictors in a non-COVID ischemic stroke control cohort.

Results:

A total of 1,827 patients were included in the derivation cohort (AIS N = 44; no AIS N = 1,783). Among all hospitalized COVID-19 patients, history of prior stroke and platelet count ≥ 200 × 1,000/µL at hospital presentation were independent predictors of AIS (derivation AUC 0.89, validation AUC 0.82), irrespective of COVID-19 severity. Among hospitalized COVID-19 patients with a neurologic symptom (N = 827), the risk of AIS was significantly higher among patients with a history of prior stroke and age <60 (derivation AUC 0.83, validation AUC 0.81). Notably, in a non-COVID ischemic stroke control cohort (N = 168), AIS patients were significantly older and less likely to have had a prior stroke, demonstrating the uniqueness of AIS patients with COVID-19.

Conclusions:

Hospitalized COVID-19 patients who demonstrate a neurologic symptom and have either a history of prior stroke or are of younger age are at higher risk of ischemic stroke.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Front Neurol Year: 2021 Document Type: Article Affiliation country: Fneur.2021.741044

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Front Neurol Year: 2021 Document Type: Article Affiliation country: Fneur.2021.741044