Cerebrovascular disease and mortality in hospitalized patients with COVID-19 in a Latin American country, Peru.
Resumen
Objective: This study aimed at: 1) Assessment of the frequency of stroke and related mortality rate in patients hospitalized for COVID-19 in two major hospital referral centers in Peru; 2) Exploration of factors associated to mortality and dependency in these patients; 3) Comparisons of frequency of admissions of stroke patients and reperfusion treatments in similar periods of time prior to (2019) and during the pandemia occurrence. Material and Methods: A retrospective cohort study was conducted in two of the largest referral hospital centers for COVID-19 in Peru. The study included patient victims of stroke and COVID-19, hospitalized between April and August 2020. Demographic, clinical and laboratory data, radiological findings, and severity levels measured by the NIHSS scale were collected. Poisson regression models to evaluate associated factors to mortality and dependency were applied. Results: A 31% reduction of admissions for stroke, and of 81% of intravenous reperfusion treatment, respectively, were found in 2020 when compared with 2019. 1.37% of the patients with COVID-19 experienced a stroke, with an overall mortality rate of 40.6%, and a dependency rate of 68.3% at discharge time (Rankin > 2). An age increase of 10 years was found in mortality, associated with a 29% increase in mortality risk. As well, having hypertension, chronic kidney disease, inflammatory markers (D dimer and ferritin) and the severity of the stroke were associated with mortality. Finally, the severity of stroke, lymphopenia, and inflammatory markers (D dimer and fibrinogen) were associated with greater risk of dependency. Conclusions: The care system of stroke patients was affected by the COVID-19 pandemic in two of Perú’s major public hospitals. There was a decrease in admissions and reperfusion treatments of stroke cases, and 1.37% of patients with COVID-19 presented a stroke. Age, hypertension, chronic kidney disease, inflammatory markers and severity of stroke were associated with mortality in these patients.
Referencias
Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648
Leira EC, Russman AN, Biller J, Brown DL, Bushnell CD, Caso V, et al. Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions. Neurology. 2020; 95(3):124-133. doi: 10.1212/WNL.0000000000009713
Merkler AE, Parikh NS, Mir S, et al. Risk of Ischemic Stroke in Patients with Coronavirus Disease 2019 (COVID-19) vs Patients with Influenza. JAMA Neurol. 2020;77(11):1366–1372. doi:10.1001/jamaneurol.2020.2730
Dafer RM, Osteraas ND, Biller J. Acute Stroke Care in the Coronavirus Disease 2019 Pandemic. J Stroke Cerebrovasc Dis. 2020; 29(7):104881. doi:10.1016/j.jstrokecerebrovasdis.2020.104881
Tan YK, Goh C, Leow AST, Tambyah PA, Ang A, Yap ES, et al. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis. 2020; 50(3):587-595. doi: 10.1007/s11239-020-02228-y
Rodriguez F, Solomon N, de Lemos JA, Das SR, Morrow DA, Bradley SM, et al. Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized With COVID-19: Findings From the American Heart Association's COVID-19 Cardiovascular Disease Registry. Circulation. 2021; 143(24): 2332-2342. doi: 10.1161/CIRCULATIONAHA.120.052278
Escalera-Antezana JP, Lizon-Ferrufino NF, Maldonado-Alanoca A, Alarcon-De-la-Vega G, Alvarado-Arnez LE, Balderrama-Saavedra MA, et al. Risk factors for mortality in patients with Coronavirus Disease 2019 (COVID-19) in Bolivia: An analysis of the first 107 confirmed cases. Infez Med. 2020;28(2):238-242.
Nannoni S, de Groot R, Bell S, Markus HS. Stroke in COVID-19: A systematic review and meta-analysis. Int J Stroke. 2021;16(2):137-149. doi:10.1177/1747493020972922
The Economist. Tracking covid-19 excess deaths across countries. The Economist; 2021. (Accessed Feb 4, 2022) Available at: https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker
Baracchini C, Pieroni A, Viaro F, Cianci V, Cattelan AM, Tiberio I, et al. Acute stroke management pathway during Coronavirus-19 pandemic. Neurol Sci 2020;41(5):1003-100
Markus HS, Brainin M. COVID-19 and stroke-A global World Stroke Organization perspective. Int J Stroke. 2020;15(4):361-364. doi: 10.1177/1747493020923472
Zhao J, Li H, Kung D, Fisher M, Shen Y, Liu R. Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions. Stroke. 2020;51(7):1996-2001. doi: 10.1161/STROKEAHA.120.030225.
Derraz I. Stroke Health Care Use and COVID-19. AJNR Am J Neuroradiol. 2020; 41(6): E36. doi: 10.3174/ajnr.A6563
Siegler JE, Cardona P, Arenillas JF, Talavera B, Guillen AN, Chavarría-Miranda A, et al. Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry. Int J Stroke. 2021;16(4):437-447. doi: 10.1177/1747493020959216
Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-147. doi: 10.1016/j.thromres.2020.04.013
Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14. doi: 10.1016/j.thromres.2020.04.024
Ghannam M, Alshaer Q, Al-Chalabi M, Zakarna L, Robertson J, Manousakis G. Neurological involvement of coronavirus disease 2019: a systematic. Review. J Neurol. 2020; 1: 1–19. doi: 10.1007/s00415-020-09990-2
Zakeri A, Jadhav AP, Sullenger BA, Nimjee SM. Ischemic stroke in COVID-19-positive patients: an overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist. J Neurointerv Surg. 2021;13(3):202-206. doi: 10.1136/neurintsurg-2020-016794
Soto-Cámara R, González-Bernal JJ, González-Santos J, Aguilar-Parra JM, Trigueros R, López-Liria R. Knowledge on Signs and Risk Factors in Stroke Patients. J Clin Med. 2020;9(8):2557. doi:10.3390/jcm9082557
Fridman S, Bres-Bullrich M, Jimenez-Ruiz A, Costantini P, Shah P, Just C, et al. Stroke risk, phenotypes, and death in COVID-19: Systematic review and newly reported cases. Neurology. 2020;95(24):e3373-e3385. doi: 10.1212/WNL.0000000000010851
Rothstein A, Oldridge O, Schwennesen H, Do D, Cucchiara BL. Acute Cerebrovascular Events in Hospitalized COVID-19 Patients. Stroke. 2020;51(9):e219-e222. doi: 10.1161/STROKEAHA.120.030995
Yaghi S, Ishida K, Torres J, Mac Grory B, Raz E, Humbert K, et al. SARS-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020;51(7):2002-2011. doi: 10.1161/STROKEAHA.120.030335.
Martins SO, Mont'Alverne F, Rebello LC, Abud DG, Silva GS, Lima FO, et al. Thrombectomy for Stroke in the Public Health Care System of Brazil. N Engl J Med. 2020;382(24):2316-2326. doi: 10.1056/NEJMoa2000120. PMID: 32521133.
Hsiao J, Sayles E, Antzoulatos E, Stanton RJ, Sucharew H, Broderick JP, et al. Effect of COVID-19 on Emergent Stroke Care: A Regional Experience. Stroke. 2020;51(9):e2111-e2114. doi: 10.1161/STROKEAHA.120.030499
Plumereau C, Cho TH, Buisson M, Amaz C, Cappucci M, Derex L, et al. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network. J Neurol. 2021;268(7):2314-2319. doi: 10.1007/s00415-020-10199-6
Vences MA, Pareja-Ramos JJ, Otero P, Veramendi-Espinoza LE, Vega-Villafana M, Mogollón-Lavi J, et al. Factors associated with mortality in patients hospitalized with COVID-19: A prospective cohort in a Peruvian national referral hospital. Medwave. 2021;21(6):e8231. doi: 10.5867/medwave.2021.06.8231
Pranata R, Huang I, Lim MA, Wahjoepramono EJ, July J. Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19-systematic review, meta-analysis, and meta-regression. J Stroke Cerebrovasc Dis. 2020; 29(8):104949. doi:10.1016/j.jstrokecerebrovasdis.2020.104949
Jain R, Young M, Dogra S, Kennedy H, Nguyen V, Jones S, et al. COVID-19 related neuroimaging findings: A signal of thromboembolic complications and a strong prognostic marker of poor patient outcome. J Neurol Sci. 2020;414:116923. doi: 10.1016/j.jns.2020.116923
Nannoni S, de Groot R, Bell S, Markus HS. Stroke in COVID-19: A systematic review and meta-analysis. Int J Stroke. 2021;16(2):137-149. doi:10.1177/1747493020972922
Ntaios G, Michel P, Georgiopoulos G, Guo Y, Li W, Xiong J, et al. Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry. Stroke. 2020;51(9):e254-e258. doi: 10.1161/STROKEAHA.120.031208
Rothstein A, Oldridge O, Schwennesen H, Do D, Cucchiara BL. Acute Cerebrovascular Events in Hospitalized COVID-19 Patients. Stroke. 2020; 51(9):e219-e222. doi:10.1161/STROKEAHA.120.030995
Malik P, Patel U, Mehta D, Patel N, Kelkar R, Akrmah M, et al. Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis. BMJ Evid Based Med. 2021;26(3):107-108. doi: 10.1136/bmjebm-2020-111536.
Marta-Enguita J, Corroza-Laviñeta J, Ostolaza A. Risk factors and severity predictors in COVID-19 hospitalized patients: Analysis of 52 patients: Factores de riesgo y predictores de gravedad en pacientes hospitalizados por COVID-19: análisis de 52 casos. Med Clin (Engl Ed). 2020;155(8):360-361. doi: 10.1016/j.medcle.2020.06.018
Derechos de autor 2022 Marla Gallo-Guerrero, Miguel A. Vences, Jessica Hanae Zafra-Tanaka, Diego Galindo, Maira Saavedra, Cynthia Zevallos
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
La RNP se distribuye bajo una Licencia Creative Commons Atribución 4.0 Internacional.
Los autores ceden sus derechos a la RNP para que esta divulgue el artículo a través de los medios que disponga. La revista proporcionará formatos de declaración jurada de autoría y autorización para la publicación del artículo, los cuales deben ser entregados junto al manuscrito.
Los autores mantienen el derecho a compartir, copiar, distribuir, ejecutar y comunicar públicamente su artículo, o parte de él, mencionando la publicación original en la revista. Los autores pueden archivar en el repositorio de su institución:
- La tesis de grado de la cual derive el artículo publicado.
- La versión pre-print: versión previa a la revisión por pares.
- La versión post-print: versión final posterior a la revisión por pares.
- La versión definitiva o versión final creada por el editor para su publicación.
