Details der Publikation - COVID-19 Stroke Apical Lung Examination Study 2

COVID-19 Stroke Apical Lung Examination Study 2 : a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2)

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved..

BACKGROUND: Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19.

OBJECTIVE: To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients.

METHODS: In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed.

RESULTS: CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality.

CONCLUSION: Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.

Medienart:	E-Artikel

Erscheinungsjahr:	2024
Erschienen:	2024

Enthalten in:	Zur Gesamtaufnahme - volume:42
Enthalten in:	NeuroImage. Clinical - 42(2024) vom: 15. März, Seite 103590

Sprache:	Englisch

Beteiligte Personen:	Ratneswaren, T [VerfasserIn] Chan, N [VerfasserIn] Aeron-Thomas, J [VerfasserIn] Sait, S [VerfasserIn] Adesalu, O [VerfasserIn] Alhawamdeh, M [VerfasserIn] Benger, M [VerfasserIn] Garnham, J [VerfasserIn] Dixon, L [VerfasserIn] Tona, F [VerfasserIn] McNamara, C [VerfasserIn] Taylor, E [VerfasserIn] Lobotesis, K [VerfasserIn] Lim, E [VerfasserIn] Goldberg, O [VerfasserIn] Asmar, N [VerfasserIn] Evbuomwan, O [VerfasserIn] Banerjee, S [VerfasserIn] Holm-Mercer, L [VerfasserIn] Senor, J [VerfasserIn] Tsitsiou, Y [VerfasserIn] Tantrige, P [VerfasserIn] Taha, A [VerfasserIn] Ballal, K [VerfasserIn] Mattar, A [VerfasserIn] Daadipour, A [VerfasserIn] Elfergani, K [VerfasserIn] Barker, R [VerfasserIn] Chakravartty, R [VerfasserIn] Murchison, A G [VerfasserIn] Kemp, B J [VerfasserIn] Simister, R [VerfasserIn] Davagnanam, I [VerfasserIn] Wong, O Y [VerfasserIn] Werring, D [VerfasserIn] Banaras, A [VerfasserIn] Anjari, M [VerfasserIn] Rodrigues, J C L [VerfasserIn] Thompson, C A S [VerfasserIn] Haines, I R [VerfasserIn] Burnett, T A [VerfasserIn] Zaher, R E Y [VerfasserIn] Reay, V L [VerfasserIn] Banerjee, M [VerfasserIn] Sew Hee, C S L [VerfasserIn] Oo, A P [VerfasserIn] Lo, A [VerfasserIn] Rogers, P [VerfasserIn] Hughes, T [VerfasserIn] Marin, A [VerfasserIn] Mukherjee, S [VerfasserIn] Jaber, H [VerfasserIn] Sanders, E [VerfasserIn] Owen, S [VerfasserIn] Bhandari, M [VerfasserIn] Sundayi, S [VerfasserIn] Bhagat, A [VerfasserIn] Elsakka, M [VerfasserIn] Hashmi, O H [VerfasserIn] Lymbouris, M [VerfasserIn] Gurung-Koney, Y [VerfasserIn] Arshad, M [VerfasserIn] Hasan, I [VerfasserIn] Singh, N [VerfasserIn] Patel, V [VerfasserIn] Rahiminejad, M [VerfasserIn] Booth, T C [VerfasserIn] RADIANT Group [VerfasserIn]

Links:	Volltext

Themen:	COVID-19 Diagnostic biomarker Journal Article Lung apices Stroke

Anmerkungen:	Date Revised 29.03.2024 published: Print-Electronic Citation Status Publisher

doi:	10.1016/j.nicl.2024.103590

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	NLM370031164

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520			\|a BACKGROUND: Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19
520			\|a OBJECTIVE: To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients
520			\|a METHODS: In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed
520			\|a RESULTS: CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality
520			\|a CONCLUSION: Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage
650		4	\|a Journal Article
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650		4	\|a Lung apices
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COVID-19 Stroke Apical Lung Examination Study 2 : a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2)

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