Indicators of High Morbidity and Poor Functional Outcome in Acute Ischemic Stroke Patients with Concurrent COVID-19 - Abstract
Objectives: Evidence suggests an association of increased cerebrovascular accidents frequency in patients diagnosed with the novel coronavirus disease, COVID-19. Coagulopathy resulting from the 2019 novel coronavirus (SARS-CoV-2) infection is suspected. The current study aims at evaluating inflammatory and thrombotic markers in relation to stroke severity and functional outcomes in a patient cohort of acute ischemic stroke (AIS) with concurrent COVID-19. Materials and Methods: We performed a retrospective observational cohort study of 28 patients who tested positive for SARS-CoV-2 via polymerase chain reaction and concomitant AIS confirmed by brain imaging. We collected and analyzed data regarding initial stroke presentation, markers of coagulopathy, morbidity, and 90-day functional outcomes. Results: The patient cohort had median NIHSS of 16 at initial presentation and median stroke volume of 52 mL. Median 90-day mRS was 4. Highest fibrinogen level recorded showed a median of 759.54 mg/dL, D-dimer and lactate dehydrogenase (LDH) showed a median of 12,463 ng/mL and 442 ng/mL closest to stroke symptoms onset, respectively. LDH (p=0.0008), D-dimer (p=0.001), and maximum fibrinogen levels (p=0.049) near the time of stroke significantly predicted final NIHSS and functional outcome 90-days after discharge. Conclusions: Adult patients with AIS and concurrent COVID-19 disease exhibited abnormally high markers of inflammation and coagulopathy, and LDH, D-Dimer, and fibrinogen levels were predictors of morbidity and neurological disability at 90-days in this patient population. Further research is necessary to establish a definitive pattern and assess the ability to use these markers as prognostic elements of morbidity and mortality.