bims-covirf 2021-11-21 papers

Issue of 2021–11–21
two papers selected by
Catherine Rycroft, BresMed

Stroke. 2021 Nov 16. STROKEAHA121036257

Increased COVID-19 Mortality in People With Previous Cerebrovascular Disease: A Population-Based Cohort Study.

Uxue Lazcano, Elisa Cuadrado-Godia, María Grau, Isaac Subirana, Elisenda Martínez-Carbonell, Marc Boher-Massaguer, Ana Rodríguez-Campello, Eva Giralt-Steinhauer, Isabel Fernández-Pérez, Jordi Jiménez-Conde, Jaume Roquer, Ángel Ois.

BACKGROUND AND PURPOSE: The aim of the study was to determine the association between previous stroke and mortality after coronavirus disease 2019 (COVID-19) according to sex, age groups, and stroke subtypes.
METHODS: Prospective population-based cohort study including all COVID-19 positive cases between February 1 and July 31, 2020. Comorbidities and mortality were extracted using linked health administration databases. Previous stroke included transient ischemic attack, ischemic stroke, hemorrhagic stroke, spontaneous subarachnoid hemorrhage, and combined stroke for cases with more than one category. Other comorbidities were obesity, diabetes, hypertension, ischemic heart disease, atrial fibrillation, heart failure, chronic obstructive pulmonary disease, chronic kidney disease, cirrhosis, dementia, individual socioeconomic index, and deprivation index. Cases were followed up until December 31, 2020. Primary outcome was mortality of any cause after COVID-19 positivity. Cox proportional regression analysis adjusted for comorbidities was used. Stratified analyses were performed for sex and age (<60, 60-79, and ≥80 years).
RESULTS: There were 91 629 COVID-19 cases. Previous strokes were 5752 (6.27%), of which 3887 (67.57%) were ischemic, 1237 (21.50%) transient ischemic attack, 255 (4.43%) combined, 203 (3.53%) hemorrhagic, and 170 (2.96%) subarachnoid hemorrhage. There were 9512 deaths (10.38%). Mortality was associated with previous stroke (hazard ratio [HR]=1.12 [95% CI, 1.06-1.18], P<0.001), in both sexes separately (men=1.13 [1.05-1.22], P=0.001; women=1.09 [1.01-1.18], P=0.023), in people <60 years (HR=2.97 [1.97-4.48], P<0.001) and 60 to 79 years (HR=1.32 [1.19-1.48], P<0.001) but not in people ≥80 years (HR=1.02 [0.96-1.09], P=0.437). Ischemic (HR=1.11 [1.05-1.18], P=0.001), hemorrhagic (HR=1.53 [1.20-1.96], P=0.001) and combined (HR=1.31 [1.05-1.63], P=0.016) strokes were associated but not transient ischemic attack. Subarachnoid hemorrhage was associated only in people <60 years (HR=5.73 [1.82-18.06], P=0.003).
CONCLUSIONS: Previous stroke was associated with a higher mortality in people younger than 80 years. The association occurred for both ischemic and hemorrhagic stroke but not for transient ischemic attack. These data might help healthcare authorities to establish prioritization strategies for COVID-19 vaccination.

Keywords: COVID-19; hemorrhagic stroke; ischemic stroke; mortality; subarachnoid hemorrhage; transient ischemic attack

DOI: https://doi.org/10.1161/STROKEAHA.121.036257

Epidemiol Prev. 2021 ;45 In press

Metabolic syndrome and risk of COVID-19-related hospitalization: a large, population-based cohort study carried out during the first European outbreak of SARS-CoV-2 infection in the Metropolitan area of Milan (Lombardy Region, Northern Italy).

Federico Gervasi, Anita Andreano, Antonio Giampiero Russo.

BACKGROUND: since the beginning of the COVID-19 pandemic, specific characteristics of the infected subjects appeared to be associated with a severe disease, leading to hospitalization or death.
OBJECTIVES: to evaluate the association between three components of the metabolic syndrome (diabetes mellitus, dyslipidaemia, and hypertension), alone and in combination, and risk of hospitalization in subjects with nasopharyngeal swab-confirmed COVID-19.
DESIGN: cohort study.
SETTING AND PARTICIPANTS: the study subjects were all COVID-19 cases diagnosed in the area of the Agency for Health Protection of the Metropolitan Area of Milan (Lombardy Region, Northern Italy) between 10.02.2020 and 25.04.2020, whose data were gathered with an ad hoc information system developed at the beginning of the pandemic.
MAIN OUTCOME MEASURES: the association between metabolic syndrome components (alone and in combination) and hospitalization (both in any ward and in intensive care unit) was measured by means of cause-specific Cox models with gender, age, and comorbidities as potential confounders.
RESULTS: the cohort included 15,162 subjects followed from diagnosis up to 20.07.2020. Adjusted hazard ratios (HRs) of hospitalization in any ward estimated by the Cox model were 1.26 for uncomplicated diabetes mellitus (95%CI 1.18-1.34); 1.21 for complicated diabetes mellitus (95%CI 1.05-1.39); 1.07 for dyslipidaemia (95%CI 1.00-1.14); and 1.11 for hypertension (95%CI 1.05-1.17). When all components coexisted in the same subject, the HR was 1.46 (95%CI 1.31-1.62). A significant increase in risk of hospitalization in intensive care unit was found for uncomplicated diabetes mellitus (HR 1.38; 95%CI 1.15-1.66).
CONCLUSIONS: this population-based study confirms that metabolic syndrome components increase the risk of hospitalization for COVID-19. The HR increases in an additive manner when the three components are simultaneously present.

Keywords: COVID-19; hospitalization (risk of); metabolic syndrome (as a risk factor)

DOI: https://doi.org/10.19191/EP21.6.115