key: cord-321097-fw05hcr4
authors: Annie, Frank; Bates, Mark C.; Nanjundappa, Aravinda; Bhatt, Deepak L.; Alkhouli, Mohamad
title: Prevalence and Outcomes of Acute Ischemic Stroke Among Patients ≤ 50 Years of Age with Laboratory Confirmed COVID-19 Infection
date: 2020-06-14
journal: Am J Cardiol
DOI: 10.1016/j.amjcard.2020.06.010
sha: 
doc_id: 321097
cord_uid: fw05hcr4

nan

The COVID-19 epidemic has led to an unpreceded disruption in health care systems worldwide.

Concerns have been recently raised about young patients with COVID-19 presenting with large ischemic strokes 1 . Data on stroke in COVID-19 patients remain limited to a few case reports. 1 In this focused analysis, we investigated the incidence and outcomes of acute ischemic stroke in young adults using a multinational database.

We queried the TriNetx Research Network to select patients <50 years of age with laboratory confirmed COVID-19 infection between January 20, 2020 to April 24, 2020. Patients Pearson chi-squared test for categorical variables and an independent-samples t-test for continuous variables. All-cause mortality was displayed in the 2 cohorts using the Kaplan Meier method, and statistical significance of the differences between the 2 groups were assessed with the Log-Rank Test.

A total of 9,358 COVID-19 positive patients age ≤ 50 years of age were identified in the database, of whom 33.2% were hospitalized for severe symptoms. The incidence of acute ischemic stroke was 64/9,358 (0.7%). Compared with patients who did not experience a stroke, those with acute ischemic strokes were older (39.39.0 vs. 36.78.5 years, P<0.001), but had similar proportions of females (60.9% vs. 60.4%, P=0.93). They, however, had higher prevalence of key co-morbidities: hypertension (61.0% vs. 11.7%); diabetes (32.8% vs. 6.5%); heart failure To our knowledge, this is the first study to report the incidence and outcomes of acute ischemic stroke in young adults with COVID-19 infection. We found a low overall incidence but a grim prognosis of acute ischemic stroke among unselected young adults with COVID-19. The findings of this analysis need to be interpreted in the context of its limitations. Due to the nature of this observational database, it is not possible to distinguish whether patients presented with strokes then tested positive for COVID-19 or vice versa. Also, given the lack of a control arm without COVID-19, these findings cannot confirm an association between COVID-19 and increased risk of ischemic stroke especially with the higher prevalence of comorbidities in the stroke cohort.

Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young

Validation of Acute Ischemic Stroke Codes Using the International Classification of Diseases Tenth Revision

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Large artery ischaemic stroke in severe acute respiratory syndrome (SARS)

Kaplan Meier Survival Analysis of Young Adults with COVID-19 with or without Stroke