The Characteristics and Pathophysiological Mechanisms of Stroke in COVID-19 Patients Stroke in COVID-19 patients
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Abstract
Objective: Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome (SARS)-like coronaviruses (SARS-CoV-2). Although the respiratory system is mainly affected, multiple organ systems like the central nervous system (CNS) might be complicated by COVID-19. Stroke is one of the most common complications of COVID-19. In the literature, the symptoms and effects of COVID-19 on stroke have been reported but potential reasons and results remain unclear. In this study, we aimed to determine whether COVID-19 plays a role in stroke and affects the prevalence of stroke and mortality by investigating blood parameters, day of stroke after COVID-19, death status, and infarct volume.
Methods: In this cross-sectional clinical research, 74 individuals participated. Twenty-two patients were COVID-19 cases without stroke; thirty participants were patients with COVID-19 and stroke, while twenty-two were cases of non-COVID-19 and stroke. Data were collected from a single center, Basaksehir Cam and Sakura City Hospital and were presented as mean ± standard deviation (SD).
Results: There was a statistically significant relationship among the age, D-dimer, INR, and lymphocyte values of the living group compared to those of the exitus group. The association between death and COVID-19 status was found to be statistically significant, indicating that the number of deaths in the COVID-19 and stroke group was higher than in the only stroke group (i.e., non-COVID-19 cases). No statistically significant relationship was observed between the alive and exitus groups in terms of the volume of infarction.
Conclusions: This study comprehensively evaluated the relationship between COVID-19, stroke, and mortality. Given the relatively limited number of cases in this study, further investigation is needed to elucidate the connection among COVID-19, neurological complications of the disease, and mortality. In the meantime, the results of this study contribute to the understanding of the relationship between COVID-19, neurological complications, and mortality, providing additional valuable data to the existing literature.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2024-01-13
Published 2024-01-14
References
Wang D, Hu B et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. Doi:10.1001/jama.2020.1585 DOI: https://doi.org/10.1001/jama.2020.1585
Xu YH, Dong JH et al. Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2. J Infect 2020; 80: 394–400. DOI: https://doi.org/10.1016/j.jinf.2020.02.017
Beyrouti R, Adams ME et al. Characteristics of ischemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2020; 91: 889–891. DOI: https://doi.org/10.1136/jnnp-2020-323586
Dogra S, Jain R et al. Hemorrhagic stroke and anticoagulation in COVID-19. J Stroke Cerebrovasc Dis 2020; 29: 104984. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104984
Valderrama EV, Humbert K et al. Severe acute respiratory syndrome coronavirus 2 infection and ischemic stroke. Stroke 2020; 51: e124–e127. DOI: https://doi.org/10.1161/STROKEAHA.120.030153
South K, McCulloch L et al. Preceding infection and risk of stroke: an old concept revived by the COVID-19 pandemic. Int J Stroke 2020; 15: 722–732. DOI: https://doi.org/10.1177/1747493020943815
Nannoni S, de Groot R et al. Stroke in COVID-19: A systematic review and meta-analysis. International Journal of Stroke 2021; 16(2)137-149 DOI: https://doi.org/10.1177/1747493020972922
Hess DC, Eldahshan W et al. COVID-19 – related stroke. Transl Stroke Res 2020; 11: 322–325.
Iba T, Levy JH et al. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Thromb Haemost 2019; 17: 1989–1994. DOI: https://doi.org/10.1111/jth.14578
Fan S, Xiao M et al. Neurological manifestations in critically ill patients with COVID-19: a retrospective study. Front Neurol 2020; 11: 806. DOI: https://doi.org/10.3389/fneur.2020.00806
Zhang Y, Xiao M et al. Coagulopathy and anti-phospholipid antibodies in patients with Covid-19. N Engl J Med 2020; 382: e38. DOI: https://doi.org/10.1056/NEJMc2007575
Spence JD, de Freitas GR et al. Mechanisms of stroke in COVID-19. Cerebrovasc Dis 2020; 49: 451–458. DOI: https://doi.org/10.1159/000509581
Zhou P, Yang XL et al. A pneumonia out- break associated with a new coronavirus of probable bat origin. Nature 2020; 579: 270–273. DOI: https://doi.org/10.1038/s41586-020-2012-7
Varga Z, Flammer AJ et al. Endothelial cell infection and endothelitis in COVID-19. Lancet 2020; 395: 1417–1418. DOI: https://doi.org/10.1016/S0140-6736(20)30937-5
Hess DC, Eldahshan W et al. COVID-19 – related stroke. Transl Stroke Res 2020; 11: 322–325. DOI: https://doi.org/10.1007/s12975-020-00818-9
Sardu C, Gambardella J et al. Hypertension, thrombosis, kidney failure, and diabetes: is COVID-19 an endothelial disease? A comprehensive evaluation of clinical and basic evidence. J Clin Med 2020; 9: 1417. DOI: https://doi.org/10.3390/jcm9051417
Huang C, Wang Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506 DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
Marchandot B, Sattler L et al. COVID-19 related coagulopathy: a distinct entity? J Clin Med 2020; 9: 1651. DOI: https://doi.org/10.3390/jcm9061651
Cheng R and Leedy D. COVID-19 and acute myocardial injury: the heart of the matter or an innocent bystander? Heart 2020; 106: 1122–1124. DOI: https://doi.org/10.1136/heartjnl-2020-317025
Larson AS, Savastano L et al. Coronavirus disease 2019 and the cerebrovascular-cardiovascular systems: what do we know so far? J Am Heart Assoc 2020; 9: e016793. DOI: https://doi.org/10.1161/JAHA.120.016793
Fan H, Tang Y et al. Influence of COVID-19 on cerebrovascular disease and its possible mechanism. Neuropsychiatr Dis Treat 2020; 16: 1359–1367. DOI: https://doi.org/10.2147/NDT.S251173
Co COC, Yu JRT et al. Intravenous thrombolysis for stroke in a COVID-19 positive Filipino patient, a case report. J Clin Neurosci 2020; 77: 234–236. DOI: https://doi.org/10.1016/j.jocn.2020.05.006
Helms J, Kremer S, M et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med 2020; 382: 2268–2270. DOI: https://doi.org/10.1056/NEJMc2008597
Williams OH, Mohideen S et al. Multiple internal border zone infarcts in a patient with COVID-19 and CADASIL. J Neurol Sci 2020; 416: 116980. DOI: https://doi.org/10.1016/j.jns.2020.116980
Wang H, Tang X et al. Potential mechanisms of hemorrhagic stroke in elderly COVID-19 patients. Aging 2020; 12: 10022–10034. DOI: https://doi.org/10.18632/aging.103335
Poyiadji N, Shahin G et al. COVID-19-associated acute hemorrhagic necrotizing encephalopathy: imaging features. Radiology 2020; 296: E119–E120 DOI: https://doi.org/10.1148/radiol.2020201187
Franceschi AM, Ahmed O et al. Hemorrhagic posterior reversible encephalopathy syndrome as a manifestation of COVID-19 infection. AJNR 2020; 41: 1173–1176. DOI: https://doi.org/10.3174/ajnr.A6595
Conklin J, Frosch MP et al. Cerebral microvascular injury in severe COVID-19. J Neurol Sci. 2021; 421:117308. DOI: https://doi.org/10.1016/j.jns.2021.117308
Ma Q, Liu J et al. Global percentage of asymptomatic sars-cov-2 infections among the tested population and individuals with confirmed covid-19 diagnosis: a systematic review and meta-analysis. JAMA Netw Open. 2021; 1;4(12):e2137257. DOI: https://doi.org/10.1001/jamanetworkopen.2021.37257
Li Q, Guan X et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199. DOI: https://doi.org/10.1056/NEJMoa2001316
Guan WJ, Ni ZY et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18):1708. DOI: https://doi.org/10.1056/NEJMoa2002032
Wu Y, Kang L et al. Incubation period of covid-19 caused by unique SARS-COV-2 strains: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(8):e2228008. DOI: https://doi.org/10.1001/jamanetworkopen.2022.28008
Levi M, Opal SM. Coagulation abnormalities in critically ill patients. Critical Care. 2006;10(4):222. DOI: https://doi.org/10.1186/cc4975
Levi M, Schultz M et al. Sepsis and thrombosis. Seminars in thrombosis and haemostasis. 2013;39(5):559–66. DOI: https://doi.org/10.1055/s-0033-1343894
Hoffman M, Monroe DM. 3rd A cell-based model of hemostasis. Thrombosis and haemostasis. 2001;85(6):958–65. DOI: https://doi.org/10.1055/s-0037-1615947
Fathi N, Rezaei N. Lymphopenia in COVID-19: therapeutic opportunities. Cell Biology International. 2020; 44(9):1792-1797 DOI: https://doi.org/10.1002/cbin.11403
Ruan Q, Yang K et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine. 2020;40(5):846-848. DOI: https://doi.org/10.1007/s00134-020-05991-x
Divani A, Andalip S et al. Central nervous system manifestations associated with COVID-19. Current Neurology and Neuroscience Reports. 2020;10.1007/s11910-020-01079-7 DOI: https://doi.org/10.1007/s11910-020-01086-8
Aghagoli G, Marin B et al. Neurological involvement in COVID-19 and potential mechanisms: A review. Neurocritical care society. 2020; 10.1007/s12028-020-01049-4. DOI: https://doi.org/10.1007/s12028-020-01049-4
Whittaker A, Anson M et al. Neurological manifestations of COVID-19: a systematic review and current update. Acta neurologica scandinavca. 2020; 10.1111/ane.132.66. DOI: https://doi.org/10.1111/ane.13266
Garcia-Azorin D, Abildua M et al. Neurological presentations of COVID-19: findings from the Spanish Society of neurology neuroCOCID-19 registry. Journal of the neurological sciences. 2021; 10.1016/j.jns2020.117283.
Sagris D, Papanikolaou A et al. COVID-19 and ischemic stroke. European journal of Neurology. 2021; 10.1111/ene.15008. DOI: https://doi.org/10.1111/ene.15008
Qui F, Wu Y et al. Changes of coagulation function and risk of stroke in patients with COVID-19. Brain and behaviour. 2021; 10.1002/brb3.2185.
Lu Y, Zhao J et al. The relationship between COVID-19 severity and ischemic stroke: s systematic review and meta-analysis. Neurological sciences. 2021; 10.1007/s10072-021-05299-8. DOI: https://doi.org/10.1007/s10072-021-05299-8
Lou M, Yuan D et al. Potential mechanismsof cerebrovascular diseasesin COVID-19 patients. Journal of neurovirology 2020; 10.1007/s13365-021-00948-2. DOI: https://doi.org/10.1007/s13365-021-00948-2
Tang X, Zheng F. A review of ischemic stroke in COVID-19: currently known pathophysiological mechanisms. Neurological sciences 2022; 10.1007/s10072-021-05679-0. DOI: https://doi.org/10.1007/s10072-021-05679-0