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Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Francesco Janes1,2, Emanuela Sozio3, Gian Luigi Gigli2

  • 1Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.

Frontiers in Neurology
|August 18, 2023
PubMed

Insights

COVID-19 patients experienced strokes at a rate of 1.51%, with severe COVID-19, atrial fibrillation, and ischemic heart disease as key risk factors. Obesity appeared to be protective against stroke in these patients.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiology

Background:

  • Stroke is a recognized complication of COVID-19, but its incidence, risk factors, and causal links require further elucidation.
  • Understanding the relationship between COVID-19 and stroke is critical for patient management and public health strategies.

Purpose of the Study:

  • To characterize COVID-19-associated strokes in hospitalized patients.
  • To identify independent risk factors for ischemic stroke (IS) in COVID-19 patients.
  • To classify the causal role of COVID-19 in stroke events.

Main Methods:

  • Retrospective analysis of COVID-19 patients hospitalized between November 2020 and April 2021.
  • Risk factor analysis for ischemic stroke (IS), which constituted 92% of COVID-19-related strokes.
  • Classification of causal attribution of COVID-19 to IS events.

Main Results:

  • The incidence of acute stroke among hospitalized COVID-19 patients was 1.51% (62/4105).
  • Independent risk factors for IS included severe COVID-19, atrial fibrillation, and ischemic heart disease.
  • Obesity (BMI > 30 kg/m²) was identified as a protective factor for IS (OR 0.90).
  • COVID-19 was deemed causal in 32.1%, a cofactor in 28.6%, and a possible trigger in 39.3% of IS cases.

Conclusions:

  • The observed stroke rate aligns with existing literature, validating the findings.
  • Distinguishing between IS caused by and triggered by COVID-19 is possible through specific clinical and radiological features.
  • Patient history of vascular disease and risk factors are vital for assessing IS risk in COVID-19 patients, though an obesity paradox may exist.
Abstract

Keywords:
COVID-19acquired coagulopathyacute strokeobesity paradoxtriggers of acute stroke

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