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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States
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Impact of COVID-19 on Outcomes in Ischemic Stroke Patients in the United States

机译：Covid-19对美国缺血性脑卒中患者结果的影响

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Background: Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes. Methods: We retrospectively identified patients in the Vizient Clinical Data Base (R) with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (home or acute rehabilitation). In the primary analysis, we compared IS patients with laboratory-confirmed COVID-19 (IS-COVID) discharged April 1-July 31, 2020 to pre-COVID IS patients discharged in 2019 (IS controls). In a secondary analysis, we compared a matched cohort of IS-COVID patients to patients within the IS controls who had pneumonia (IS-PNA), created with inverse-probability-weighting (IPW). Results: In the primary analysis, we included 166,586 IS controls and 2086 IS-COVID from 312 hospitals in 46 states. Compared to IS controls, IS-COVID were less likely to have hypertension, dyslipidemia, or be smokers, but more likely to be male, younger, have diabetes, obesity, acute renal failure, acute coronary syndrome, venous thromboembolism, intubation, and comorbid intracerebral or subarachnoid hemorrhage (all p<0.05). Black and Hispanic patients accounted for 21.7% and 7.4% of IS controls, respectively, but 33.7% and 18.5% of IS-COVID (p<0.001). IS-COVID, versus IS controls, were less likely to receive alteplase (1.8% vs 5.6%, p<0.001), mechanical thrombectomy (4.4% vs. 6.7%, p<0.001), to have favorable discharge (33.9% vs. 66.4%, p <0.001), but more likely to die (30.4% vs. 6.5%, p<0.001). In the matched cohort of patients with IS-COVID and IS-PNA, IS-COVID had a higher risk of death (IPW-weighted OR 1.56, 95% CI 1.33-1.82) and lower odds of favorable discharge (IPW-weighted OR 0.63, 95% CI 0.54-0.73). Conclusions: Ischemic stroke patients with COVID-19 are more likely to be male, younger, and Black or Hispanic, with significant increases in morbidity and mortality compared to both ischemic stroke controls from 2019 and to patients with ischemic stroke and pneumonia.
机译：背景：研究表明，共病缺血性中风（IS）和2019年冠状病毒病（COVID-19）患者的预后较差，但样本量较小。方法：我们回顾性地确定Vizient临床数据库（R）中的IS患者作为出院诊断。研究结果为住院死亡和良好出院（家庭或急性康复）。2019冠状病毒疾病患者的实验室检查证实COVID-19（IS-COVID）出院，四月至1-7月31, 2020至2019岁前出院（对照组）。在二级分析中，我们比较了一组匹配的IS-COVID患者与IS对照组中患有肺炎（IS-PNA）的患者，后者采用逆概率加权（IPW）法。结果：在初步分析中，我们纳入了来自46个州的312家医院的166586名IS对照和2086名IS-COVID。与IS对照组相比，IS-COVID患高血压、血脂异常或吸烟的可能性较小，但男性、年轻人、糖尿病、肥胖、急性肾功能衰竭、急性冠状动脉综合征、静脉血栓栓塞、插管和合并脑内或蛛网膜下腔出血的可能性更大（均p<0.05）。黑人和西班牙裔患者分别占IS对照组的21.7%和7.4%，但占IS-COVID的33.7%和18.5%（p<0.001）。与IS对照组相比，IS-COVID组接受阿替普酶治疗（1.8%对5.6%，p<0.001）、机械血栓切除术（4.4%对6.7%，p<0.001）的可能性较小（33.9%对66.4%，p<0.001），但死亡的可能性更大（30.4%对6.5%，p<0.001）。在IS-COVID和IS-PNA患者的配对队列中，IS-COVID患者的死亡风险较高（IPW加权OR 1.56，95%可信区间1.33-1.82），出院的几率较低（IPW加权OR 0.63，95%可信区间0.54-0.73）。结论：2019冠状病毒疾病患者更容易成为男性、年轻、黑人或西班牙裔患者，其发病率和死亡率显著高于缺血性卒中和肺炎患者，且与2019和缺血性卒中和肺炎患者相比。

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