Τίτλος:
Sars-cov-2 is a culprit for some, but not all acute ischemic strokes: A report from the multinational covid-19 stroke study group
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investi-gated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addi-tion, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6–14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8–40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4–36.2) were associated with cardioembolic stroke. Conclusions. Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
Συγγραφείς:
Shahjouei, S.
Anyaehie, M.
Koza, E.
Tsivgoulis, G.
Naderi, S.
Mowla, A.
Avula, V.
Sadr, A.V.
Chaudhary, D.
Farahmand, G.
Griessenauer, C.
Azarpazhooh, M.R.
Misra, D.
Li, J.
Abedi, V.
Zand, R.
the Multinational COVID-Stroke Study Group
Περιοδικό:
Journal of Clinical Medicine Research
Λέξεις-κλειδιά:
adult; aged; Article; atrial fibrillation; brain atherosclerosis; brain ischemia; cardioembolic stroke; cohort analysis; comorbidity assessment; coronavirus disease 2019; female; human; ischemic heart disease; k means clustering; learning algorithm; major clinical study; male; multicenter study; neoplasm; neuroimaging; observational study; prospective study; risk assessment; stroke patient; unsupervised machine learning
