Clinical characteristics of stroke in SARS-CoV-2 infected patients in Japan: A prospective nationwide study

• Published in: Journal of the neurological sciences 2024-02, Vol.457, p.122865-122865, Article 122865
• Main Authors: Nishiyama, Yasuhiro, Miyamoto, Susumu, Sakaguchi, Manabu, Sakai, Nobuyuki, Yoshida, Kensaku, Tokuda, Naoki, Ichi, Shunsuke, Iguchi, Yasuyuki, Koga, Masatoshi, Yamaura, Ikuya, Hirano, Teruyuki, Yamagami, Hiroshi, Kimura, Kazumi
• Format: Article
• Language: English
• Subjects: COVID-19; D-dimer; Large vessel occlusion; Poor outcome; Stroke
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2023.122865

We investigated the clinical characteristics and outcomes of stroke in SARS-CoV-2 infected patients in Japan. This prospective, multicenter observational study of stroke in patients with SARS-CoV-2 infection involving 563 primary stroke centers across Japan was conducted between July 2020, and May 2022. We included 159 stroke cases (131 ischemic stroke, 2 transient ischemic attack (TIA), 21 intracranial hemorrhage, and 5 subarachnoid hemorrhage) and collected their clinical characteristics. Ischemic stroke and TIA (n = 133) were analyzed separately. The mean age of the 159 patients was 70.6 years, with 66% being men. Poor outcomes (modified Rankin Scale score 5–6) occurred in 40% (63/159) at discharge. Among patients with ischemic stroke and TIA, 30%, 18%, 10%, and 42% had cardioembolism, large-artery atherosclerosis, small-vessel occlusion, and cryptogenic stroke or embolic stroke of undetermined source, respectively. One-third (34%) presented with large vessel occlusion (LVO) of the internal carotid, middle cerebral M1, or basilar arteries. Poor outcomes included age (adjusted odds ratio (aOR): 1.06, 95%CI: 1.01–1.12), ischemic heart disease (IHD) history (aOR: 13.00, 95%CI: 1.51–111.70), moderate to severe pneumonia (aOR: 7.78, 95%CI: 1.18–51.42), an National Institutes of Health Stroke Scale score at baseline (aOR: 1.10, 95%CI: 1.03–1.17), LVO (aOR: 14.88, 95%CI: 2.33–94.97), and log10 D-dimer (aOR: 3.38, 95%CI: 1.01–11.26). Upon discharge, 40% of SARS-CoV-2 infected patients with ischemic stroke and TIA had poor outcomes. Poor outcomes were associated with older age, IHD history, moderate to severe pneumonia, higher NIHSS scores, LVO, and higher log10 D-dimer. Registration: UMIN Clinical Trials Registry: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000041226. •Clinical features & outcomes of stroke in SARS-CoV-2 infected patients in Japan are unknown.•Poor outcomes at discharge were observed in 40% of stroke in SARS-CoV-2 infected patients.•Mortality was observed in 18% of stroke in SARS-CoV-2 infected patients.•Poor outcomes were associated with age, IHD history, pneumonia, NIHSS scores, LVO, and D-dimer.