Predictors of mortality for patients with COVID-19 and large vessel occlusion

David J. Altschul, Charles Esenwa, Neil Haranhalli, Santiago R. Unda, Rafael de La Garza Ramos, Joseph Dardick, Jenelys Fernandez-Torres, Aureliana Toma, Daniel Labovitz, Natalie Cheng, Seon Kyu Lee, Allan Brook, Richard Zampolin

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: This study evaluates the mortality risk of patients with emergent large vessel occlusion (ELVO) and COVID-19 during the pandemic. Methods: We performed a retrospective cohort study of two cohorts of consecutive patients with ELVO admitted to a quaternary hospital from March 1 to April 17, 2020. We abstracted data from electronic health records on baseline, biomarker profiles, key time points, quality measures and radiographic data. Results: Of 179 patients admitted with ischemic stroke, 36 had ELVO. Patients with COVID-19 and ELVO had a higher risk of mortality during the pandemic versus patients without COVID-19 (OR 16.63, p = 0.004). An age-based sub-analysis showed in-hospital mortality in 60% of COVID-19 positive patients between 61-70 years-old, 66.7% in between 51-60 years-old, 50% in between 41-50 years-old and 33.3% in between 31-40 years old. Patients that presented with pulmonary symptoms at time of stroke presentation had 71.4% mortality rate. 27.3% of COVID-19 patients presenting with ELVO had a good outcome at discharge (mRS 0-2). Patients with a history of cigarette smoking (p = 0.003), elevated d-dimer (p = 0.007), failure to recanalize (p = 0.007), and elevated ferritin levels (p = 0.006) had an increased risk of mortality. Conclusion: Patients with COVID-19 and ELVO had a significantly higher risk for mortality compared to COVID-19 negative patients with ELVO. A small percentage of COVID-19 ELVO patients had good outcomes. Age greater than 60 and pulmonary symptoms at presentation have higher risk for mortality. Other risk factors for mortality were a history of cigarette smoking, elevated, failure to recanalize, elevated d-dimer and ferritin levels.

Original languageEnglish (US)
Pages (from-to)623-628
Number of pages6
JournalInterventional Neuroradiology
Volume26
Issue number5
DOIs
StatePublished - Oct 1 2020

Keywords

  • COVID-19
  • Ischemic stroke
  • emergent large vessel occlusion
  • mechanical thrombectomy
  • outcomes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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