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Updated: Jul 28, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
A Severity Score and Outcome Prediction in Patients that Suffered an Ischemic Stroke
Corina Roman-Filip1,2, Maria-Gabriela Catană Vlădoiu1,2, Mădălina Văleanu3
1Neurology Department, Emergency County Clinical Hospital Sibiu, Corneliu Coposu bvd, Sibiu 550245, Romania.
Insights
A new stroke severity index aids in managing patients with and without SARS-CoV-2 infection. This index predicts mortality risk, incorporating biomarkers and clinical factors for better patient care.
Area of Science:
- Neurology
- Infectious Diseases
- Biomarkers
Background:
- Stroke is a leading cause of death and disability globally.
- SARS-CoV-2 infection presents significant clinical challenges, including hypercoagulability and increased stroke risk.
- Predicting stroke mortality remains a critical challenge for clinicians.
Purpose of the Study:
- To develop a stroke severity index applicable to both SARS-CoV-2 infected and non-infected stroke patients.
- To aid in the clinical management of stroke patients, considering COVID-19 status.
- To identify key factors influencing stroke severity and mortality.
Main Methods:
- A prospective study included 80 ischemic stroke patients (40 with SARS-CoV-2 infection).
- Biomarkers such as hs-CRP, IL-6, fibrinogen, ESR, D-dimer, leucocytes, lymphocytes, and NLR were analyzed.
- Comparison of biomarker levels and outcomes between infected and non-infected cohorts.
Main Results:
- SARS-CoV-2 stroke patients showed elevated inflammatory biomarkers (hs-CRP, IL-6, D-dimer) compared to non-infected patients.
- Mortality risk was 4.2 times higher in SARS-CoV-2 stroke patients.
- An NIHSS score >15 significantly increased mortality risk (9.16 times higher).
Conclusions:
- A novel stroke severity score was developed, integrating NIHSS, age, gender, COVID-19 status, and biomarkers (hs-PCR, IL-6, D-dimer, fibrinogen, ESR).
- This index can serve as a valuable tool for guiding patient management in stroke, with or without SARS-CoV-2 infection.
- The findings highlight the critical role of inflammation and hypercoagulability in stroke outcomes during the COVID-19 pandemic.
Background:
Stroke is the main cause of disability and exitus worldwide. The prediction of mortality of this pathology represents a major challenge. More than that, the infection with the SARS-CoV-2 virus is a challenge for every clinician worldwide, and hypercoagulability is one of its biggest concerns that can lead to stroke.
Objective:
Our aim was to develop a severity stroke index for both SARS-CoV-2 stroke patients and noninfected stroke patients which we hope to be helpful in patient's management.
Methods:
We conducted a prospective study during January 2021-June 2021 which included 80 patients who suffered an ischemic stroke, 40 of which had both stroke and SARS-CoV-2 infection. We have established a panel of biomarkers including CRP, IL-6, fibrinogen, ESR, D-dimer, leucocytes, lymphocytes, and NLR and compared the results of our two cohorts.
Results:
SARS-CoV-2 stroke patients have experienced elevated levels of biomarkers that rise in inflammation such as hs-CRP, IL-6, and D-dimer, comparing to noninfected stroke patients. Also, the probability of exitus in SARS-CoV-2 patients is 4.2 times higher than in noninfected subjects. With regard to stroke severity, we have concluded that a NIHSS score higher than 15 points considerably influences the death rate, the probability of exitus being 9.16 times higher than in NIHSS score lower than 15.
Conclusion:
Based on our result, we have established a severity score index which includes NIHSS score, age, gender, the presence/absence of COVID-19 infection, and the following biomarkers: hs-PCR, IL-6, D-dimer, fibrinogen, and ESR, which can be used as a tool to guide patient's management.
