Neurology Xagena

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Stroke risk, phenotypes, and death in COVID-19

A study has investigated the hypothesis that strokes occurring in patients with COVID-19 have distinctive features.

Researchers have performed a systematic search resulting in 10 studies reporting stroke frequency among COVID-19 patients, which were pooled with one unpublished series from Canada.
an Additional systematic search for cases series of stroke in COVID-19 patients ( n=125 ) was performed.
These data were pooled with 35 unpublished cases from Canada, USA, and Iran.
Clinical characteristics and in-hospital mortality stratified into age groups ( less than 50, 50-70, more than 70 years ) were analyzed.

The proportion of COVID-19 patients with stroke ( 1.8%, 95% CI 0.9-3.7% ) and in-hospital mortality ( 34.4%, 95% CI 27.2-42.4% ) were exceedingly high.

Mortality was 67% lower in patients less than 50 years-old relative to those more than 70 years-old ( odds ratio, OR 0.33, 95% CI 0.12-0.94, P=0.039 ).

Large vessel occlusion was twice as frequent ( 46.9% ) as previously reported and was high across all age groups, even in the absence of risk factors or comorbidities.

A clinical phenotype characterized by older age, a higher burden of comorbidities, and severe COVID-19 respiratory symptoms, was associated with the highest in-hospital mortality ( 58.6% ) and a 3x higher risk of death than the rest of the cohort ( OR 3.52, 95% CI 1.53-8.09, P=0.003 ).

In conclusion, stroke is relatively frequent among COVID-19 patients and has devastating consequences across all ages.
The interplay of older age, comorbidities, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality. ( Xagena )

Fridman S et al, Neurology 2020; Online ahead of print