tetano
Editor, Senior Moderator
Stroke
. 2021 May 10;STROKEAHA120031971.
doi: 10.1161/STROKEAHA.120.031971. Online ahead of print.
Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients
Lindsay S McAlpine[SUP] 1 [/SUP], Adeel S Zubair[SUP] 1 [/SUP], Ilavarasy Maran[SUP] 1 [/SUP], Pola Chojecka[SUP] 1 [/SUP], Paul Lleva[SUP] 1 [/SUP], Adam S Jasne[SUP] 1 [/SUP], Dhasakumar Navaratnam[SUP] 1 [/SUP], Charles Matouk[SUP] 2 [/SUP], Joseph Schindler[SUP] 1 [/SUP], Kevin N Sheth[SUP] 1 [/SUP], Hyung Chun[SUP] 3 [/SUP], Alfred I Lee[SUP] 4 [/SUP], Serena Spudich[SUP] 1 [/SUP], Richa Sharma[SUP] #[/SUP][SUP] 1 [/SUP], Lauren H Sansing[SUP] #[/SUP][SUP] 1 5 [/SUP]
Affiliations
Abstract
Background and purpose: Reports indicate an increased risk of ischemic stroke during coronavirus disease 2019 (COVID-19) infection. We aimed to identify patients with COVID-19 and ischemic stroke and explore markers of inflammation, hypercoagulability, and endotheliopathy, a structural and functional disturbance of the vascular endothelium due to a stressor.
Methods: This was a retrospective, observational cohort study comparing acute ischemic stroke patients with and without COVID-19 across 3 hospitals. Timing of stroke onset during COVID-19 course and markers of inflammation, hypercoagulability, and endothelial activation were evaluated by COVID-19 status and stroke cause.
Results: Twenty-one patients with ischemic stroke were diagnosed with COVID-19 during the study period. Patients with COVID-19 had a similar age and burden of vascular risk factors compared with the control cohort (n=168). We identified a temporal correlation between stroke onset and the peak of acute phase reactants, including CRP (C-reactive protein), ferritin, and d-dimer. In subsets of patients with labs available, embolic stroke of undetermined source was associated with elevated IL (interleukin)-6 (median, 171 [interquartile range, 13-375] versus 8 [4-11], P<0.01) and sIL (soluble IL)-2 receptor (1972 [1525-4720] versus 767 [563-1408.5], P=0.05) levels. Stroke patients with COVID-19 demonstrated elevated levels of endothelial activation markers compared with non-COVID-19 stroke controls (median von Willebrand activity 285.0% [interquartile range, 234%-382%] versus 150% [128%-183%], P=0.034; von Willebrand antigen 330.0% [265%-650%] versus 152% [130%-277%], P=0.007, and factor VIII 301% [289%-402%] versus 49% [26%-94%], P<0.001).
Conclusions: Ischemic stroke in patients with COVID-19 is associated with endotheliopathy and a systemic inflammatory response in patients with vascular risk factors. Further research evaluating endothelial and inflammatory markers in the setting of ischemic stroke and COVID-19 in larger, prospective cohorts is needed to validate the findings.
Keywords: coronavirus; cytokines; embolic stroke; ischemic stroke; von Willebrand Factor.
. 2021 May 10;STROKEAHA120031971.
doi: 10.1161/STROKEAHA.120.031971. Online ahead of print.
Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients
Lindsay S McAlpine[SUP] 1 [/SUP], Adeel S Zubair[SUP] 1 [/SUP], Ilavarasy Maran[SUP] 1 [/SUP], Pola Chojecka[SUP] 1 [/SUP], Paul Lleva[SUP] 1 [/SUP], Adam S Jasne[SUP] 1 [/SUP], Dhasakumar Navaratnam[SUP] 1 [/SUP], Charles Matouk[SUP] 2 [/SUP], Joseph Schindler[SUP] 1 [/SUP], Kevin N Sheth[SUP] 1 [/SUP], Hyung Chun[SUP] 3 [/SUP], Alfred I Lee[SUP] 4 [/SUP], Serena Spudich[SUP] 1 [/SUP], Richa Sharma[SUP] #[/SUP][SUP] 1 [/SUP], Lauren H Sansing[SUP] #[/SUP][SUP] 1 5 [/SUP]
Affiliations
- PMID: 33966492
- DOI: 10.1161/STROKEAHA.120.031971
Abstract
Background and purpose: Reports indicate an increased risk of ischemic stroke during coronavirus disease 2019 (COVID-19) infection. We aimed to identify patients with COVID-19 and ischemic stroke and explore markers of inflammation, hypercoagulability, and endotheliopathy, a structural and functional disturbance of the vascular endothelium due to a stressor.
Methods: This was a retrospective, observational cohort study comparing acute ischemic stroke patients with and without COVID-19 across 3 hospitals. Timing of stroke onset during COVID-19 course and markers of inflammation, hypercoagulability, and endothelial activation were evaluated by COVID-19 status and stroke cause.
Results: Twenty-one patients with ischemic stroke were diagnosed with COVID-19 during the study period. Patients with COVID-19 had a similar age and burden of vascular risk factors compared with the control cohort (n=168). We identified a temporal correlation between stroke onset and the peak of acute phase reactants, including CRP (C-reactive protein), ferritin, and d-dimer. In subsets of patients with labs available, embolic stroke of undetermined source was associated with elevated IL (interleukin)-6 (median, 171 [interquartile range, 13-375] versus 8 [4-11], P<0.01) and sIL (soluble IL)-2 receptor (1972 [1525-4720] versus 767 [563-1408.5], P=0.05) levels. Stroke patients with COVID-19 demonstrated elevated levels of endothelial activation markers compared with non-COVID-19 stroke controls (median von Willebrand activity 285.0% [interquartile range, 234%-382%] versus 150% [128%-183%], P=0.034; von Willebrand antigen 330.0% [265%-650%] versus 152% [130%-277%], P=0.007, and factor VIII 301% [289%-402%] versus 49% [26%-94%], P<0.001).
Conclusions: Ischemic stroke in patients with COVID-19 is associated with endotheliopathy and a systemic inflammatory response in patients with vascular risk factors. Further research evaluating endothelial and inflammatory markers in the setting of ischemic stroke and COVID-19 in larger, prospective cohorts is needed to validate the findings.
Keywords: coronavirus; cytokines; embolic stroke; ischemic stroke; von Willebrand Factor.