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COVID-19 Severity and Stroke: Correlation of Imaging and Laboratory Markers
J M Katz1, R B Libman1, J J Wang2
1From the Department of Neurology (J.M.K., R.B.L., M.G., S.V.P., R.I.K., S.N., S.A.).
Insights
Patients hospitalized with severe COVID-19 and stroke showed more frequent infarctions and bleeding. These patients also had higher inflammatory markers, indicating a prothrombotic state, requiring careful anticoagulation management.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- Coronavirus disease 2019 (COVID-19) is an independent risk factor for stroke.
- Understanding stroke patterns in COVID-19 patients is crucial for effective treatment.
Purpose of the Study:
- To compare stroke characteristics and inflammatory markers in patients hospitalized with severe COVID-19 versus those with out-of-hospital stroke onset.
- To investigate the association between severe COVID-19 and stroke severity and outcomes.
Main Methods:
- Retrospective case series of COVID-19 positive patients with confirmed stroke.
- Analysis of clinical, laboratory (including inflammatory markers), and imaging data.
- Comparison between in-hospital severe COVID-19 stroke and out-of-hospital milder COVID-19 stroke cases.
Main Results:
- Patients with severe COVID-19 and stroke had significantly more frequent infarctions (95.1% vs 73.3%) and associated hemorrhage (31.7% vs 4.4%).
- Severe COVID-19 stroke patients exhibited higher C-reactive protein, ferritin, and D-dimer levels, alongside lymphopenia and organ injury.
- Multivascular infarctions were more common in the severe COVID-19 group (56.4% vs 33.3%).
Conclusions:
- Hospitalized severe COVID-19 patients with stroke present with heightened inflammation, coagulopathy, and tissue damage biomarkers.
- These findings support hyperinflammation leading to a prothrombotic state in severe COVID-19.
- Anticoagulation strategies require careful consideration of both thrombosis and hemorrhagic transformation risks.
Background And Purpose:
Coronavirus disease 2019 (COVID-19) appears to be an independent risk factor for stroke. We hypothesize that patients who develop stroke while hospitalized for severe COVID-19 will have higher inflammatory markers and distinct stroke imaging patterns compared with patients positive for COVID-19 with out-of-hospital stroke onset and milder or no COVID-19 symptoms.
Materials And Methods:
This is a retrospective case series of patients positive for COVID-19 on polymerase chain reaction testing with imaging-confirmed stroke treated within a large health care network in New York City and Long Island between March 14 and April 26, 2020. Clinical and laboratory data collected retrospectively included complete blood counts and creatinine, alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer levels. All CT and MR imaging studies were independently reviewed by 2 neuroradiologists who recorded stroke subtype and patterns of infarction and intracranial hemorrhage.
Results:
Compared with patients with COVID-19 with outside-of-hospital stroke onset and milder or no COVID-19 symptoms (n = 45, 52.3%), patients with stroke already hospitalized for severe COVID-19 (n = 41, 47.7%) had significantly more frequent infarctions (95.1% versus 73.3%, P = .006), with multivascular distributions (56.4% versus 33.3%, P = .022) and associated hemorrhage (31.7% versus 4.4%, P = .001). Patients with stroke admitted with more severe COVID-19 had significantly higher C-reactive protein and ferritin levels, elevated D-dimer levels, and more frequent lymphopenia and renal and hepatic injury (all, P < .003).
Conclusions:
Patients with stroke hospitalized with severe COVID-19 are characterized by higher inflammatory, coagulopathy, and tissue-damage biomarkers, supporting proposed pathogenic mechanisms of hyperinflammation activating a prothrombotic state. Cautious balancing of thrombosis and the risk of hemorrhagic transformation is warranted when considering anticoagulation.
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