Dataset Information

SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy.

ABSTRACT:

Objective

To characterize patients with acute ischemic stroke related to SARS-CoV-2 infection and assess the classification performance of clinical and laboratory parameters in predicting in-hospital outcome of these patients.

Methods

In the setting of the STROKOVID study including patients with acute ischemic stroke consecutively admitted to the ten hub hospitals in Lombardy, Italy, between March 8 and April 30, 2020, we compared clinical features of patients with confirmed infection and non-infected patients by logistic regression models and survival analysis. Then, we trained and tested a random forest (RF) binary classifier for the prediction of in-hospital death among patients with COVID-19.

Results

Among 1013 patients, 160 (15.8%) had SARS-CoV-2 infection. Male sex (OR 1.53; 95% CI 1.06-2.27) and atrial fibrillation (OR 1.60; 95% CI 1.05-2.43) were independently associated with COVID-19 status. Patients with COVID-19 had increased stroke severity at admission [median NIHSS score, 9 (25th to75th percentile, 13) vs 6 (25th to75th percentile, 9)] and increased risk of in-hospital death (38.1% deaths vs 7.2%; HR 3.30; 95% CI 2.17-5.02). The RF model based on six clinical and laboratory parameters exhibited high cross-validated classification accuracy (0.86) and precision (0.87), good recall (0.72) and F1-score (0.79) in predicting in-hospital death.

Conclusions

Ischemic strokes in COVID-19 patients have distinctive risk factor profile and etiology, increased clinical severity and higher in-hospital mortality rate compared to non-COVID-19 patients. A simple model based on clinical and routine laboratory parameters may be useful in identifying ischemic stroke patients with SARS-CoV-2 infection who are unlikely to survive the acute phase.

SUBMITTER: Pezzini A

PROVIDER: S-EPMC8142879 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Publications

SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy.

Pezzini Alessandro A Grassi Mario M Silvestrelli Giorgio G Locatelli Martina M Rifino Nicola N Beretta Simone S Gamba Massimo M Raimondi Elisa E Giussani Giuditta G Carimati Federico F Sangalli Davide D Corato Manuel M Gerevini Simonetta S Masciocchi Stefano S Cortinovis Matteo M La Gioia Sara S Barbieri Francesca F Mazzoleni Valentina V Pezzini Debora D Bonacina Sonia S Pilotto Andrea A Benussi Alberto A Magoni Mauro M Premi Enrico E Prelle Alessandro Cesare AC Agostoni Elio Clemente EC Palluzzi Fernando F De Giuli Valeria V Magherini Anna A Roccatagliata Daria Valeria DV Vinciguerra Luisa L Puglisi Valentina V Fusi Laura L Diamanti Susanna S Santangelo Francesco F Xhani Rubjona R Pozzi Federico F Grampa Giampiero G Versino Maurizio M Salmaggi Andrea A Marcheselli Simona S Cavallini Anna A Giossi Alessia A Censori Bruno B Ferrarese Carlo C Ciccone Alfonso A Sessa Maria M Padovani Alessandro A

Journal of neurology 20210524 1

<h4>Objective</h4>To characterize patients with acute ischemic stroke related to SARS-CoV-2 infection and assess the classification performance of clinical and laboratory parameters in predicting in-hospital outcome of these patients.<h4>Methods</h4>In the setting of the STROKOVID study including patients with acute ischemic stroke consecutively admitted to the ten hub hospitals in Lombardy, Italy, between March 8 and April 30, 2020, we compared clinical features of patients with confirmed infec ...[more]

PMID: 34031747

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Project description:BackgroundRobust data on case fatality rate (CFR) among inpatients with COVID-19 are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. This study quantified the overall CFR and described its trend in a cohort of hospitalized patients with SARS-CoV-2 in Italy. Admission to ICU, death, or discharge were the secondary outcomes.MethodsThis retrospective study is based on administrative health data and electronic case records of inpatients consecutively admitted to Niguarda Hospital between 21 February and 8 November 2020.ResultsAn overall CFR of 18% was observed. CFR was significantly reduced during the second wave of contagion (1 June to 30 September, 16%) compared with the first wave (21 February to 31 May, 21% p = 0.015). Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was associated with a high risk of mortality in both waves. The incidence of severe disease and the need for ICU admission were lower in the second wave.ConclusionCFR in SARS-CoV-2 inpatients was demonstrated to decrease over time. This reduction may partly reflect the changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to plan an exit strategy in case of future outbreaks.Key messagesWhat is already known on this topic Before the advent of anti-COVID-19 vaccines, a multi-wave pattern of contagion was observed, and this trend conditioned the inpatient case fatality rate (CFR), which varied over time accordingly to the waves of contagion.Only preliminary results on the in-hospital mortality trend are available, along with a partial analysis of its determinants. Consequently, robust data on CFR among inpatients with SARS-CoV-2 infection are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. What this study adds This study shows that the in-hospital mortality in patients with SARS-CoV-2 infection decreases over time.Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was invariably associated with a high risk of mortality during the whole study period (21 February to 8 November 2020), but the incidence of severe disease and the need for ICU admission were lower in the second wave of contagions (1 October to 8 November 2020). This reduction may partly reflect the impact of changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to inform the response to future outbreaks and to plan exit strategy by prioritizing high-risk populations.Supplementary informationThe online version contains supplementary material available at 10.1007/s10389-021-01675-y.

Dataset Information

SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy.

Objective

Methods

Results

Conclusions

Publications

SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy.

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