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Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza.
Merkler, Alexander E; Parikh, Neal S; Mir, Saad; Gupta, Ajay; Kamel, Hooman; Lin, Eaton; Lantos, Joshua; Schenck, Edward J; Goyal, Parag; Bruce, Samuel S; Kahan, Joshua; Lansdale, Kelsey N; LeMoss, Natalie M; Murthy, Santosh B; Stieg, Philip E; Fink, Matthew E; Iadecola, Costantino; Segal, Alan Z; Cusick, Marika; Campion, Thomas R; Diaz, Ivan; Zhang, Cenai; Navi, Babak B.
  • Merkler AE; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Parikh NS; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Mir S; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Gupta A; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Kamel H; Department of Radiology, Weill Cornell Medicine, New York, New York.
  • Lin E; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Lantos J; Deputy Editor.
  • Schenck EJ; Department of Radiology, Weill Cornell Medicine, New York, New York.
  • Goyal P; Department of Radiology, Weill Cornell Medicine, New York, New York.
  • Bruce SS; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
  • Kahan J; Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York.
  • Lansdale KN; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • LeMoss NM; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Murthy SB; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Stieg PE; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Fink ME; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Iadecola C; Department of Neurosurgery, Weill Cornell Medicine, New York, New York.
  • Segal AZ; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Cusick M; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Campion TR; Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York.
  • Diaz I; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
  • Zhang C; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
  • Navi BB; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York.
JAMA Neurol ; 2020 Jul 02.
Article in English | MEDLINE | ID: covidwho-627768
Semantic information from SemMedBD (by NLM)
1. Influenza PROCESS_OF Patients
Subject
Influenza
Predicate
PROCESS_OF
Object
Patients
2. Ischemic stroke PROCESS_OF Patients
Subject
Ischemic stroke
Predicate
PROCESS_OF
Object
Patients
3. COVID-19 PREDISPOSES Ischemic stroke
Subject
COVID-19
Predicate
PREDISPOSES
Object
Ischemic stroke
4. American College of Cardiology/American Heart Association Lesion Complexity Score C COEXISTS_WITH COVID-19
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
Predicate
COEXISTS_WITH
Object
COVID-19
5. Cerebrovascular accident COEXISTS_WITH Respiratory viruses
Subject
Cerebrovascular accident
Predicate
COEXISTS_WITH
Object
Respiratory viruses
6. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
7. Nasopharynx LOCATION_OF 2019 novel coronavirus
Subject
Nasopharynx
Predicate
LOCATION_OF
Object
2019 novel coronavirus
8. Acute Cerebrovascular Accidents PROCESS_OF Patients
Subject
Acute Cerebrovascular Accidents
Predicate
PROCESS_OF
Object
Patients
9. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
10. Blood Vessel LOCATION_OF risk factors
Subject
Blood Vessel
Predicate
LOCATION_OF
Object
risk factors
11. Ischemic stroke PROCESS_OF Adult
Subject
Ischemic stroke
Predicate
PROCESS_OF
Object
Adult
12. COVID-19 PROCESS_OF Adult
Subject
COVID-19
Predicate
PROCESS_OF
Object
Adult
13. Hospitals LOCATION_OF Retrospective Cohort Study
Subject
Hospitals
Predicate
LOCATION_OF
Object
Retrospective Cohort Study
14. COVID-19 COEXISTS_WITH Thrombus
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Thrombus
15. Influenza PROCESS_OF Patients
Subject
Influenza
Predicate
PROCESS_OF
Object
Patients
16. Ischemic stroke PROCESS_OF Patients
Subject
Ischemic stroke
Predicate
PROCESS_OF
Object
Patients
17. COVID-19 PREDISPOSES Ischemic stroke
Subject
COVID-19
Predicate
PREDISPOSES
Object
Ischemic stroke
18. American College of Cardiology/American Heart Association Lesion Complexity Score C COEXISTS_WITH COVID-19
Subject
American College of Cardiology/American Heart Association Lesion Complexity Score C
Predicate
COEXISTS_WITH
Object
COVID-19
19. Cerebrovascular accident COEXISTS_WITH Respiratory viruses
Subject
Cerebrovascular accident
Predicate
COEXISTS_WITH
Object
Respiratory viruses
20. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
21. Nasopharynx LOCATION_OF 2019 novel coronavirus
Subject
Nasopharynx
Predicate
LOCATION_OF
Object
2019 novel coronavirus
22. Acute Cerebrovascular Accidents PROCESS_OF Patients
Subject
Acute Cerebrovascular Accidents
Predicate
PROCESS_OF
Object
Patients
23. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
24. Blood Vessel LOCATION_OF risk factors
Subject
Blood Vessel
Predicate
LOCATION_OF
Object
risk factors
25. Ischemic stroke PROCESS_OF Adult
Subject
Ischemic stroke
Predicate
PROCESS_OF
Object
Adult
26. COVID-19 PROCESS_OF Adult
Subject
COVID-19
Predicate
PROCESS_OF
Object
Adult
27. Hospitals LOCATION_OF Retrospective Cohort Study
Subject
Hospitals
Predicate
LOCATION_OF
Object
Retrospective Cohort Study
28. COVID-19 COEXISTS_WITH Thrombus
Subject
COVID-19
Predicate
COEXISTS_WITH
Object
Thrombus
ABSTRACT
IMPORTANCE It is uncertain whether coronavirus disease 2019 (COVID-19) is associated with a higher risk of ischemic stroke than would be expected from a viral respiratory infection.

OBJECTIVE:

To compare the rate of ischemic stroke between patients with COVID-19 and patients with influenza, a respiratory viral illness previously associated with stroke. DESIGN, SETTING, AND

PARTICIPANTS:

This retrospective cohort study was conducted at 2 academic hospitals in New York City, New York, and included adult patients with emergency department visits or hospitalizations with COVID-19 from March 4, 2020, through May 2, 2020. The comparison cohort included adults with emergency department visits or hospitalizations with influenza A/B from January 1, 2016, through May 31, 2018 (spanning moderate and severe influenza seasons). EXPOSURES COVID-19 infection confirmed by evidence of severe acute respiratory syndrome coronavirus 2 in the nasopharynx by polymerase chain reaction and laboratory-confirmed influenza A/B. MAIN OUTCOMES AND

MEASURES:

A panel of neurologists adjudicated the primary outcome of acute ischemic stroke and its clinical characteristics, mechanisms, and outcomes. We used logistic regression to compare the proportion of patients with COVID-19 with ischemic stroke vs the proportion among patients with influenza.

RESULTS:

Among 1916 patients with emergency department visits or hospitalizations with COVID-19, 31 (1.6%; 95% CI, 1.1%-2.3%) had an acute ischemic stroke. The median age of patients with stroke was 69 years (interquartile range, 66-78 years); 18 (58%) were men. Stroke was the reason for hospital presentation in 8 cases (26%). In comparison, 3 of 1486 patients with influenza (0.2%; 95% CI, 0.0%-0.6%) had an acute ischemic stroke. After adjustment for age, sex, and race, the likelihood of stroke was higher with COVID-19 infection than with influenza infection (odds ratio, 7.6; 95% CI, 2.3-25.2). The association persisted across sensitivity analyses adjusting for vascular risk factors, viral symptomatology, and intensive care unit admission. CONCLUSIONS AND RELEVANCE In this retrospective cohort study from 2 New York City academic hospitals, approximately 1.6% of adults with COVID-19 who visited the emergency department or were hospitalized experienced ischemic stroke, a higher rate of stroke compared with a cohort of patients with influenza. Additional studies are needed to confirm these findings and to investigate possible thrombotic mechanisms associated with COVID-19.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Risk factors Topics: Long Covid Language: English Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Risk factors Topics: Long Covid Language: English Year: 2020 Document Type: Article