Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Nguyen, Thanh N.; Qureshi, Muhammad M.; Klein, Piers; Yamagami, Hiroshi; Abdalkader, Mohamad; Mikulík, Robert; Sathya, Anvitha; Mansour, Ossama Yassin; Członkowska, Anna; Lo, Hannah C.; Field, Thalia S.; Charidimou, Andreas; Banerjee, Soma; Yaghi, Shadi; Siegler, James E.; Šedová, Petra; Kwan, Joseph; Sousa, Diana Aguiar de; Demeestere, Jelle; Inoa, Violiza; Omran, Setareh Salehi; Zhang, Liqun; Michel, Patrik; Strambo, Davide; Marto, João Pedro; Nogueira, Raul G

doi:10.5853/jos.2022.00752

Cited by 28 publications

(26 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, the primary outcome of this study, mRS 3–6 at 90-day follow-up, was low at 15.6%. While this is consistent with prior studies [ 5 , 40 ], it is possible that other factors such as concomitant COVID-19 infection [ 41 , 42 ] are relevant in the prognostication of CVT but were undetected in this study due to a small effect size.…”

Section: Discussionsupporting

confidence: 92%

Outcome Prediction in Cerebral Venous Thrombosis: The IN-REvASC Score

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background We identified risk factors, derived and validated a prognostic score for poor neurological outcome and death for use in cerebral venous thrombosis (CVT). Methods We performed an international multicenter retrospective study including consecutive patients with CVT from January 2015 to December 2020. Demographic, clinical, and radiographic characteristics were collected. Univariable and multivariable logistic regressions were conducted to determine risk factors for poor outcome, mRS 3-6. A prognostic score was derived and validated. Results A total of 1,025 patients were analyzed with median 375 days (interquartile range [IQR], 180 to 747) of follow-up. The median age was 44 (IQR, 32 to 58) and 62.7% were female. Multivariable analysis revealed the following factors were associated with poor outcome at 90- day follow-up: active cancer (odds ratio [OR], 11.20; 95% confidence interval [CI], 4.62 to 27.14; P<0.001), age (OR, 1.02 per year; 95% CI, 1.00 to 1.04; P=0.039), Black race (OR, 2.17; 95% CI, 1.10 to 4.27; P=0.025), encephalopathy or coma on presentation (OR, 2.71; 95% CI, 1.39 to 5.30; P=0.004), decreased hemoglobin (OR, 1.16 per g/dL; 95% CI, 1.03 to 1.31; P=0.014), higher NIHSS on presentation (OR, 1.07 per point; 95% CI, 1.02 to 1.11; P=0.002), and substance use (OR, 2.34; 95% CI, 1.16 to 4.71; P=0.017). The derived IN-REvASC score outperformed ISCVT-RS for the prediction of poor outcome at 90-day follow-up (area under the curve [AUC], 0.84 [95% CI, 0.79 to 0.87] vs. AUC, 0.71 [95% CI, 0.66 to 0.76], χ2 P<0.001) and mortality (AUC, 0.84 [95% CI, 0.78 to 0.90] vs. AUC, 0.72 [95% CI, 0.66 to 0.79], χ2 P=0.03). Conclusions Seven factors were associated with poor neurological outcome following CVT. The INREvASC score increased prognostic accuracy compared to ISCVT-RS. Determining patients at highest risk of poor outcome in CVT could help in clinical decision making and identify patients for targeted therapy in future clinical trials.

show abstract

Section: Discussionsupporting

confidence: 92%

Outcome Prediction in Cerebral Venous Thrombosis: The IN-REvASC Score

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Secondarily, we defined the second wave as the first definition, with the addition of two or more months apart between the peak of the first wave and the start of the second wave. 31…”

Section: Setting and Participantsmentioning

confidence: 99%

“…The start date for this occurrence was chosen as the minimum closest to the second wave. Secondarily, we defined the second wave as the first definition, with the addition of 2 or more months apart between the peak of the first wave and the start of the second wave 31 (eTable 2).…”

Section: Setting and Participantsmentioning

confidence: 99%

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events

Nguyen

Qureshi²,

Klein³

et al. 2023

Neurology

Self Cite

View full text Add to dashboard Cite

Background and Objectives:Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).Methods:We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.Results:There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations.Discussion:There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.Trial Registration Information:This study is registered underNCT04934020.

show abstract

“…The start date for this occurrence was chosen as the case volume minimum closest to the second wave. Our secondary definition was the primary definition plus a minimum of 2 months between the peak of the first wave and the start of the second wave 14 15. Centres were divided by low-volume, intermediate-volume and high-volume strata by mean monthly volume tertiles for COVID-19 hospitalisation submitted data (<26.33 vs >26.33 to 126.53 vs >126.53).…”

Section: Methodsmentioning

confidence: 99%

Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

2022

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

BackgroundPrior studies indicated a decrease in the incidences of aneurysmal subarachnoid haemorrhage (aSAH) during the early stages of the COVID-19 pandemic. We evaluated differences in the incidence, severity of aSAH presentation, and ruptured aneurysm treatment modality during the first year of the COVID-19 pandemic compared with the preceding year.MethodsWe conducted a cross-sectional study including 49 countries and 187 centres. We recorded volumes for COVID-19 hospitalisations, aSAH hospitalisations, Hunt-Hess grade, coiling, clipping and aSAH in-hospital mortality. Diagnoses were identified by International Classification of Diseases, 10th Revision, codes or stroke databases from January 2019 to May 2021.ResultsOver the study period, there were 16 247 aSAH admissions, 344 491 COVID-19 admissions, 8300 ruptured aneurysm coiling and 4240 ruptured aneurysm clipping procedures. Declines were observed in aSAH admissions (−6.4% (95% CI −7.0% to −5.8%), p=0.0001) during the first year of the pandemic compared with the prior year, most pronounced in high-volume SAH and high-volume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentations of subarachnoid haemorrhage (SAH) (mild: −5% (95% CI −5.9% to –4.3%), p=0.06; moderate: −8.3% (95% CI −10.2% to –6.7%), p=0.06) but no difference in higher SAH severity. The ruptured aneurysm clipping rate remained unchanged (30.7% vs 31.2%, p=0.58), whereas ruptured aneurysm coiling increased (53.97% vs 56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%, p=0.12).ConclusionDuring the first year of the pandemic, there was a decrease in aSAH admissions volume, driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the ruptured aneurysm coiling rate but neither change in the ruptured aneurysm clipping rate nor change in aSAH in-hospital mortality.Trial registration numberNCT04934020.

show abstract

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Cited by 28 publications

References 37 publications

Outcome Prediction in Cerebral Venous Thrombosis: The IN-REvASC Score

Outcome Prediction in Cerebral Venous Thrombosis: The IN-REvASC Score

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events

Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

Contact Info

Product

Resources

About