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.

Pezzini, A., Grassi, M., Silvestrelli, G., Locatelli, M., Rifino, N., Beretta, S., et al. (2022). SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy. JOURNAL OF NEUROLOGY, 269(1), 1-11 [10.1007/s00415-021-10620-8].

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

Rifino N.;Beretta S.;Giussani G.;Diamanti S.;Santangelo F.;Ferrarese C.;
2022

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.
No
Articolo in rivista - Articolo scientifico
Scientifica
COVID-19; Risk factors; Stroke; Viral infection;
English
1
11
11
Pezzini, A., Grassi, M., Silvestrelli, G., Locatelli, M., Rifino, N., Beretta, S., et al. (2022). SARS-CoV-2 infection and acute ischemic stroke in Lombardy, Italy. JOURNAL OF NEUROLOGY, 269(1), 1-11 [10.1007/s00415-021-10620-8].
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; Agostoni, E; Palluzzi, F; De Giuli, V; Magherini, A; Roccatagliata, D; 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/10281/319108
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