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Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study
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 Yal...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8524436/ https://www.ncbi.nlm.nih.gov/pubmed/34675873 http://dx.doi.org/10.3389/fneur.2021.741044 |
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author | 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 |
author_facet | 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 |
author_sort | Peng, Teng J. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8524436 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85244362021-10-20 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 Front Neurol Neurology 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. Frontiers Media S.A. 2021-10-04 /pmc/articles/PMC8524436/ /pubmed/34675873 http://dx.doi.org/10.3389/fneur.2021.741044 Text en Copyright © 2021 Peng, Jasne, Simonov, Abdelhakim, Kone, Cheng, Rethana, Tarasaria, Herman, Baker, Yaghi, Frontera, Sansing, Falcone, Spudich, Schindler, Sheth and Sharma. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology 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 Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study |
title | Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study |
title_full | Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study |
title_fullStr | Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study |
title_full_unstemmed | Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study |
title_short | Prior Stroke and Age Predict Acute Ischemic Stroke Among Hospitalized COVID-19 Patients: A Derivation and Validation Study |
title_sort | prior stroke and age predict acute ischemic stroke among hospitalized covid-19 patients: a derivation and validation study |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8524436/ https://www.ncbi.nlm.nih.gov/pubmed/34675873 http://dx.doi.org/10.3389/fneur.2021.741044 |
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