RESUMO
BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. METHODS: We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20-6/16/20). RESULTS: Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p=0.05 for all comparisons). In a multivariable backward stepwise regression model estimating the odds of in-hospital mortality, cryptogenic stroke mechanism was associated with a fivefold greater odds in-hospital mortality than strokes due to any other mechanism (adjusted OR 5.16, 95%CI 1.41-18.87, p = 0.01). In that model, older age (aOR 2.05 per decade, 95%CI 1.35-3.11, p < 0.01) and higher baseline NIHSS (aOR 1.12, 95%CI 1.02-1.21, p = 0.01) were also independently predictive of mortality. CONCLUSIONS: Our findings suggest that cryptogenic stroke among COVID-19 patients carries a significant risk of early mortality.
Assuntos
COVID-19/complicações , Mortalidade Hospitalar , AVC Isquêmico/virologia , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica , COVID-19/sangue , COVID-19/diagnóstico por imagem , COVID-19/mortalidade , Estudos de Coortes , Angiografia por Tomografia Computadorizada , Egito/epidemiologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , AVC Isquêmico/sangue , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/mortalidade , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Espanha/epidemiologia , Acidente Vascular Cerebral , Estados Unidos/epidemiologiaRESUMO
This paper presents an approach of the Government Audit used for the control of public resources in Mexico, by the Superior Audit of the Federation. It is a documentary investigation with an exploratory and descriptive scope, the method of which will obtain the information from the results of the audits of the public account 2020 carried out by the Superior Audit of the Federation, where the number of audits carried out and the fiscal resources are observed