How SARS-CoV-2 Infection Affects Outcomes of Acute Ischemic Stroke

The ongoing coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is affecting millions of people worldwide and causing high Shows mortality and morbidity. Importantly, SARS-CoV-2 infection is associated with an increased risk of thromboembolic events. Acute ischemic stroke (AIS) is one of the common cerebrovascular complications associated with COVID-19.Recent pro swan journal This study evaluated the impact of COVID-19 on neurological outcomes in patients with AIS.

study: Effect of SARS-CoV-2 infection on outcomes of acute ischemic stroke—a retrospective cohort studyImage Credit: April Stock/Shutterstock

Background

Several pathophysiological mechanisms have been found to increase the risk of ischemic stroke, including downregulation of the angiotensin-converting enzyme 2 (ACE2) receptor and myocardial injury associated with COVID-19. Multiple studies have shown that the risk of AIS increases with the severity of SARS-CoV-2 disease.

Many studies have shown that COVID-19-related stroke occurs in young patients with few or no risk factors. Moreover, most of his AIS patients with concurrent SARS-CoV-2 infection were elderly and had several cardiovascular complications. Cardiovascular risk factors have also been found to increase the risk of AIS.

About research

In the current retrospective study, we analyzed data from 32 consecutive AIS patients infected with COVID-19 between 1 March 2020 and 1 May 2021. He compared the results with 51 consecutive non-COVID-19 AIS patients.

All AIS patients considered in this study exhibited acute neurological signs of stroke and ischemia, confirmed using magnetic resonance imaging (MRI) and computed tomography (CT) of the head. rice field. For this study, the authors collected relevant demographic data, medical history, stroke characteristics, length of stay, in-hospital mortality, number of patients transferred to intensive care unit (ICU) facilities, and laboratory reports. bottom.

Investigation result

No patients with mild disease were included in the study cohort. 50% had moderate symptoms, 37.5% had severe infection, and 12.5% ​​had severe SARS-CoV-2 infection. Approximately 31% of the COVID-19 AIS group and 23.5% of the control group were treated with acute reperfusion therapy. Only the critically ill patient required her transfer to the ICU, and her hospital stay was slightly longer compared to other groups. A moderately high mortality rate was observed in patients with severe COVID-19 AIS.

Consistent with previous studies, the current study did not observe significant differences between the COVID-19 AIS and non-COVID-19 AIS groups based on age and gender. However, it should be noted that both groups were slightly male-dominated.

Regarding medical history, the authors compared the COVID-19 AIS and control groups in a history of malignancy, diabetes, ischemic heart disease, chronic kidney or lung disease, hyperlipidemia, and peripheral arterial disease (PAD). However, the prevalence of hypertension was significantly lower in the COVID-19 AIS group.The authors found that in the non-COVID-19 group, the proportion of microvascular disease etiology usually associated with hypertension was higher than in his COVID-19 group. described as higher than Additionally, all stroke risk factors were more common in COVID-19 patients.

Imaging data revealed similar territorial involvement of multiple vessels in both the COVID-19 AIS group and the non-COVID-19 AIS group. We found that the COVID-19 group had a higher rate of macrovascular occlusion and the COVID-19 AIS group had a greater anterior circulation LVO. Notably, in the COVID-19 AIS group, pneumonia patients mainly showed high LVO prevalence, indicating a stronger association between COVID-19 pneumonia and LVO. In the future, more studies are needed to validate this finding.

Interestingly, we found significant differences in lymphocyte counts (low) and C-reactive protein (CRP) levels (high) between COVID-19 and non-COVID-19 AIS patients. However, no other relevant differences were found for other tested parameters.

The COVID-19 AIS group had higher in-hospital mortality and higher disability at discharge. Based on subgroup analysis, the functional outcome of patients with anterior LVO in the COVID-19 AIS group was less favorable compared with the non-COVID-19 AIS group. A group of older adults with more cerebrovascular risk factors were found to be at higher risk of contracting COVID-19 and AIS.

Limitations of research

A major limitation of the current study is the small sample size, as a result of which the results did not reach statistical significance. Another limitation of this study’s retrospective design is that the authors evaluated only clinical laboratory and other available medical data and did not conduct patient interviews.

Conclusion

Compared with non-COVID-19 AIS, AIS with SARS-CoV-2 infection had worse functional outcomes, more severe neurological deficits and higher mortality. Moreover, severe infections were associated with worse outcomes. This study highlights the importance of providing personalized multidisciplinary care, including expertise in neurology, pulmonology and intensive care, to protect this vulnerable group from adverse outcomes. increase.