BACKGROUND Coronavirus disease 2019(COVID-19)has been shown to increase the risk of stroke.However,the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack(TIA),as w...BACKGROUND Coronavirus disease 2019(COVID-19)has been shown to increase the risk of stroke.However,the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack(TIA),as well as its impact on mor-tality,are not established.AIM To evaluate the impact of COVID-19 on in-hospital mortality,length of stay,and healthcare costs in patients with recurrent strokes.METHODS We identified admissions of recurrent stroke(current acute ischemic stroke admissions with at least one prior TIA or stroke)in patients with and without COVID-19 using ICD-10-CM codes using the National Inpatient Sample(2020).We analyzed the impact of COVID-19 on mortality following recurrent stroke admissions by subgroups.RESULTS Of 97455 admissions with recurrent stroke,2140(2.2%)belonged to the COVID-19-positive group.The COVID-19-positive group had a higher prevalence of diabetes and chronic kidney disease vs the COVID-19 negative group(P<0.001).Among the subgroups,patients aged>65 years,patients aged 45–64 years,Asians,Hispanics,whites,and blacks in the COVID-19 positive group had higher rates of all-cause mortality than the COVID-19 negative group(P<0.01).Higher odds of in-hospital mortality were seen in the group aged 45-64(OR:8.40,95%CI:4.18-16.91)vs the group aged>65(OR:7.04,95%CI:5.24-9.44),males(OR:7.82,95%CI:5.38-11.35)compared to females(OR:6.15,95%CI:4.12-9.18),and in Hispanics(OR:15.47,95%CI:7.61-31.44)and Asians/Pacific Islanders(OR:14.93,95%CI:7.22-30.87)compared to blacks(OR:5.73,95%CI:3.08-10.68),and whites(OR:5.54,95%CI:3.79-8.09).CONCLUSION The study highlights the increased risk of all-cause in-hospital mortality in recurrent stroke patients with COVID-19,with a more pronounced increase in middle-aged patients,males,Hispanics,or Asians.展开更多
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has been shown to increase the risk of stroke.However,the prevalence and risk of recurrent stroke in COVID-19 patients with prior stroke/transient ischemic attack(TIA),as well as its impact on mor-tality,are not established.AIM To evaluate the impact of COVID-19 on in-hospital mortality,length of stay,and healthcare costs in patients with recurrent strokes.METHODS We identified admissions of recurrent stroke(current acute ischemic stroke admissions with at least one prior TIA or stroke)in patients with and without COVID-19 using ICD-10-CM codes using the National Inpatient Sample(2020).We analyzed the impact of COVID-19 on mortality following recurrent stroke admissions by subgroups.RESULTS Of 97455 admissions with recurrent stroke,2140(2.2%)belonged to the COVID-19-positive group.The COVID-19-positive group had a higher prevalence of diabetes and chronic kidney disease vs the COVID-19 negative group(P<0.001).Among the subgroups,patients aged>65 years,patients aged 45–64 years,Asians,Hispanics,whites,and blacks in the COVID-19 positive group had higher rates of all-cause mortality than the COVID-19 negative group(P<0.01).Higher odds of in-hospital mortality were seen in the group aged 45-64(OR:8.40,95%CI:4.18-16.91)vs the group aged>65(OR:7.04,95%CI:5.24-9.44),males(OR:7.82,95%CI:5.38-11.35)compared to females(OR:6.15,95%CI:4.12-9.18),and in Hispanics(OR:15.47,95%CI:7.61-31.44)and Asians/Pacific Islanders(OR:14.93,95%CI:7.22-30.87)compared to blacks(OR:5.73,95%CI:3.08-10.68),and whites(OR:5.54,95%CI:3.79-8.09).CONCLUSION The study highlights the increased risk of all-cause in-hospital mortality in recurrent stroke patients with COVID-19,with a more pronounced increase in middle-aged patients,males,Hispanics,or Asians.
文摘目的探讨卒中单元院前急救流程对急性缺血性脑卒中(Acute ischemic stroke,AIS)患者静脉溶栓的临床疗效及其安全性。方法选取本院2017年6月—2018年4月进行急救标准流程溶栓的34例AIS患者作为对照组,选取本院2018年5月—2019年12月进行卒中单元院前急救流程溶栓的30例AIS患者作为观察组。比较两组患者从发病至溶栓时间(OTN)、就诊到溶栓开始时间(DTN)、入院至获得影像结果时间(DTI)、入院至获得实验室结果时间(DTL)、出/入院时美国国立卫生研究院卒中量表(NIHSS)评分,以及住院时间、并发症及临床疗效。结果观察组采用卒中单位院前急救流程,在OTN、DTN、DTI、DTL时间上与对照组相比均明显缩短,差异有统计学意义(均P<0.05)。观察组患者的总有效率高于对照组(96.7%vs 79.4%),差异有统计学意义(P<0.05),提示卒中单元院前急救模式可提高急性缺血性脑卒中患者的疗效。观察组发生脑出血2例、胃出血1例、牙龈出血1例、皮下出血1例,出血并发症发生率16.7%;对照组发生脑出血3例、胃出血2例、皮下出血1例,出血并发症发生率17.6%,两组出血并发症发生率差异无统计学意义(P>0.05)。两组患者治疗后7 d的NIHSS评分比较发现,观察组的中位评分为3分,对照组中位评分为5分,差异有统计学意义(P<0.05)。观察组患者的平均住院时间明显低于对照组(9.3 d vs 11.7 d),差异有统计学意义(P<0.05)。结论卒中单元院前急救流程明显缩短DTN时间及OTN、DTI、DTL时间,有助优化AIS诊疗流程,提高缺血性脑卒中治愈率,有利于改善患者预后,值得临床推广。
