Predictive Value of Inflammatory Biomarkers for Development of Acute Stroke in Hospitalized COVID-19 Patients

COVID-19 neurological complications have been well reported and increased level of interleukin-6 (IL-6) is proposed as a main contributing factor in stroke development. We investigate relationship between inflammatory biomarkers and acute stroke development in COVID-19 patients.

Demographic and clinical data of hospitalized COVID-19 patients including patient characteristics and laboratory biomarkers in stroke patients and controls were comparatively analyzed. Logistic regression analysis was used to analyze predictors of stroke development and receiver-operating characteristic (ROC) curve was used to discriminate main predictors for predicting stroke development.

Of the 1753 COVID-19 patients, 20 patients developed acute stroke and 80 patients were also selected as controls. Mean age of stroke patients and controls was 66.32 ± 23.07 and 54.98 ± 16.14, respectively (P = 0.017). Cardiovascular disease was more frequent in stroke patients (P = 0.049). Mean systolic blood pressure in stroke patients and controls respectively was 125.74 ± 17 017 and 118.09 ± 10.52 mmHg (P = 0.020). Mean SpO2 was lower in stroke patients (86.11 ± 4.50 vs 88.68 ± 3.92, P = 0.015) and baseline IL-6 in stroke patients showed a 3-fold increase compared with controls (P = 0.001). ICU admission (P = 0.001), decreased level of consciousness (P = 0.001), length of stay (P = 0.002), and mortality rate (P = 0.001) differed significantly between stroke patients and controls. Age (univariate [OR: 1.03, P = 0.017], multivariate [OR: 1.04, P = 0.019]), SpO2 (univariate [OR: 0.86, P = 0.021], multivariate [OR: 0.82, P = 0.040]), and IL-6 (univariate [OR: 3.62, P = 0.001], multivariate [OR: 5.19, P = 0.001]) were associate with stroke development.

High baseline IL-6 level was a potential predictor of stroke development in COVID-19 patients. Also, hypoxia and aging were associated with stroke development.