Mayo Clin Proc Innov Qual Outcomes . Stroke Features, Risk Factors and Pathophysiology in SARS-CoV-2 infected Patients

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Mayo Clin Proc Innov Qual Outcomes


. 2022 Jan 21.
doi: 10.1016/j.mayocpiqo.2022.01.003. Online ahead of print.
Stroke Features, Risk Factors and Pathophysiology in SARS-CoV-2 infected Patients


Amir A Mbonde ¹ , Cumara B O'Carroll ¹ , Marie F Grill ¹ , Nan Zhang ² , Richard Butterfield ² , Bart M Demaerschalk ¹



Affiliations

• PMID: 35079695
• PMCID: PMC8776423
• DOI: 10.1016/j.mayocpiqo.2022.01.003

Abstract

Objectives: To provide a comprehensive description of stroke characteristics, risk factors, laboratory parameters and treatment in a series of SARS-CoV-2 infected patients admitted to Mayo Clinic hospitals in Rochester MN, Jacksonville FL, Phoenix AZ, and the Mayo Clinic Health System.
Patients and methods: We retrospectively identified hospitalized patients in whom stroke and SARS-CoV-2 infection were diagnosed within the same 3-month interval between the period of September 2019 and December 2020, and extracted data on all available variables of interest. We further incorporated our findings into the existing body of basic science research to present a schematic model illustrating the proposed pathogenesis of ischemic stroke in SARS-CoV-2 infected patients.
Results: We identified 30 cases during the study period yielding a 0.5% stroke rate across 6381 SARS-CoV-2 infected hospitalized patients. Strokes were ischemic in 26/30 cases and hemorrhagic in 4/30. Traditional risk factors were common including hypertension (24/30), hyperlipidemia (18/30), smoking history (13/30), diabetes (11/30) and atrial fibrillation (8/30). The most common ischemic stroke mechanisms were cardioembolism (9/26) and cryptogenic (9/26). Intravenous alteplase and mechanical thrombectomy were administered in 2/26 and 1/26 respectively. Serum C-reactive protein median (IQR) 66 (21-210) mg/dl, interleukin-6 116 (8-400) pg/ml, D-dimer 1267 (556-4510) ng/ml , fibrinogen 711 (263-772) mg/dl and ferritin 407 (170-757) were elevated in those with available results.
Conclusion: The high prevalence of vascular risk factors and concurrent elevation of pro-inflammatory and pro-coagulation biomarkers suggests that there is an interplay between both factors in the pathogenesis of stroke in SARS-CoV-2 infected patients.

Keywords: COVID-19, Coronavirus disease 2019; EC, endothelial cells; IQR, Interquartile range; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2.