PT - JOURNAL ARTICLE AU - Fridman, Sebastian AU - Bres Bullrich, Maria AU - Jimenez-Ruiz, Amado AU - Costantini, Pablo AU - Shah, Palak AU - Just, Caroline AU - Vela-Duarte, Daniel AU - Linfante, Italo AU - Sharifi-Razavi, Athena AU - Karimi, Narges AU - Bagur, Rodrigo AU - Debicki, Derek B. AU - Gofton, Teneille E. AU - Steven, David A. AU - Sposato, Luciano A. TI - Stroke risk, phenotypes, and death in COVID-19 AID - 10.1212/WNL.0000000000010851 DP - 2020 Dec 15 TA - Neurology PG - e3373--e3385 VI - 95 IP - 24 4099 - http://n.neurology.org/content/95/24/e3373.short 4100 - http://n.neurology.org/content/95/24/e3373.full SO - Neurology2020 Dec 15; 95 AB - Objectives To investigate the hypothesis that strokes occurring in patients with coronavirus disease 2019 (COVID-19) have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population.Methods We performed a systematic search resulting in 10 studies reporting stroke frequency among patients with COVID-19, which were pooled with 1 unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in patients with COVID-19 (n = 125), and we pooled these data with 35 unpublished cases from Canada, the United States, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50–70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death.Results The proportions of patients with COVID-19 with stroke (1.8%, 95% confidence interval [CI] 0.9%–3.7%) and in-hospital mortality (34.4%, 95% CI 27.2%–42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years of age relative to those >70 years of age (odds ratio [OR] 0.33, 95% CI 0.12–0.94, p = 0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbid conditions. A clinical phenotype characterized by older age, a higher burden of comorbid conditions, and severe COVID-19 respiratory symptoms was associated with the highest in-hospital mortality (58.6%) and a 3 times higher risk of death than the rest of the cohort (OR 3.52, 95% CI 1.53–8.09, p = 0.003).Conclusions Stroke is relatively frequent among patients with COVID-19 and has devastating consequences across all ages. The interplay of older age, comorbid conditions, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.CI=confidence interval; COVID-19=coronavirus disease 2019; CVT=cerebral venous thrombosis; ICH=intracerebral hemorrhage; LVO=large vessel occlusion; OR=odds ratio; SAH=subarachnoid hemorrhage; SARS-CoV=severe acute respiratory syndrome coronavirus; uOR=unadjusted OR