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.

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

Grassi M.
Membro del Collaboration Group
;
Raimondi E.
Membro del Collaboration Group
;
Carimati F.
Membro del Collaboration Group
;
Santangelo F.
Membro del Collaboration Group
;
Versino M.
Membro del Collaboration Group
;
Sessa M.
Membro del Collaboration Group
;
2021

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.
COVID-19; Risk factors; Stroke; Viral infection
Pezzini, A.; Grassi, M.; Silvestrelli, G.; Locatelli, M.; Rifino, N.; Beretta, S.; Gamba, M.; Raimondi, E.; Giussani, G.; Carimati, F.; Sangalli, D.; Corato, M.; Gerevini, S.; Masciocchi, S.; Cortinovis, M.; La Gioia, S.; Barbieri, F.; Mazzoleni, V.; Pezzini, D.; Bonacina, S.; Pilotto, A.; Benussi, A.; Magoni, M.; Premi, E.; Prelle, A. C.; Agostoni, E. C.; Palluzzi, F.; De Giuli, V.; Magherini, A.; Roccatagliata, D. V.; Vinciguerra, L.; Puglisi, V.; Fusi, L.; Diamanti, S.; Santangelo, F.; Xhani, R.; Pozzi, F.; Grampa, G.; Versino, M.; Salmaggi, A.; Marcheselli, S.; Cavallini, A.; Giossi, A.; Censori, B.; Ferrarese, C.; Ciccone, A.; Sessa, M.; Padovani, A.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11383/2121884
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