Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Janes, Francesco; Sozio, Emanuela; Gigli, Gian Luigi; Ripoli, Andrea; Sbrana, Francesco; Kuris, Fedra; Nesi, Lorenzo; Semenzin, Tosca; Bertolino, Giacomo; Deana, Cristian; Bagatto, Daniele; Ciardi, Chiara; Fabris, Martina; Merlino, Giovanni; Bax, Francesco; Nilo, Annacarmen; Pez, Sara; Valente, Mariarosaria; Tascini, Carlo

doi:10.3389/fneur.2023.1222009

Cited by 2 publications

References 58 publications

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Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights in a Brazilian Stroke Center

de Oliveira,

Gagliardi

2024

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Introduction: More than three years into the ongoing pandemic, cerebrovascular accidents (CVAs), commonly known as strokes,have been extensively documented as a potential complication of COVID-19. Methods: Between the first and second epidemiologicalwaves of deaths, our service recorded 1,461 cases of acute respiratory syndrome with positive tests for the COVID-19 virus.During the same period, 595 patients were reported with hospitalizations/complications related to cerebrovascular syndromes.The study included a cohort of 17 patients experiencing cerebrovascular incidents, with ischemic strokes in 10 cases andhemorrhagic strokes in 7 cases. Results: The mean age was 59.8 years with a standard deviation of 14.6 years, and there was aslight female predominance with 9 female patients (52.9%). A substantial majority, 88.2%, were residents of São Paulo. It isnoteworthy that the patients with neurovascular syndrome included in the study primarily presented with symptomscharacteristic of an influenza-like syndrome (fever and cough in 64% of the cases, dyspnea in 53% of the cases), and none reportedanosmia or hyposmia as a primary complaint initially. Concerning cardiovascular risk factors, the following conditions wereassociated with cerebrovascular events: hypertension was present in 64.7% of cases, diabetes mellitus in 52.9%, active smoking in23.5%, chronic kidney disease in 11.8%, and obesity in 11.8%. Another remarkable observation from the evaluation of the selectedpatients, which has become a common finding in epidemiological studies on strokes and COVID-19, is the high rate of patientsrequiring hospitalization (88.2%). Of these hospitalized individuals, 80% required intensive care unit (ICU) support. In our caseseries, all of these (100%) presented with severe COVID-19 infection, secondary bacterial infection, as well as the necessity formechanical ventilation. Furthermore, of those admitted to the ICU, 73.3% developed acute kidney injury requiring hemodialysis,and a similar proportion succumbed to the illness (73.3%). Conclusion: Based on current evidence, the causal relationship betweencerebrovascular events and COVID-19 remains inconclusive. However, it is important to remain vigilant regarding well-establishedfacts, such as the presence of acute inflammation in response to COVID-19 infection.

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Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights in a Brazilian Stroke Center

de Oliveira,

Gagliardi

2024

Preprint

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Independent Risk Factors and Mortality Implications of De Novo Central Nervous System Involvement in Patients Hospitalized with Severe COVID-19: A Retrospective Cohort Study

Hanganu,

Dulămea,

Niculae

et al. 2024

JCM

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Background/Objectives: Central nervous system (CNS) involvement is a complication of COVID-19, adding to disease burden. The aim of this study is to identify the risk factors independently associated with CNS involvement in a cohort of patients hospitalized with severe forms of COVID-19 and the risk factors associated with all causes of in-hospital mortality and assess the impact of CNS involvement on in-hospital mortality of the severe COVID-19 patients. Methods: We performed a retrospective observational cohort study including adult patients with severe or critical forms of COVID-19 with and without new-onset CNS manifestations between March 2020 and December 2022. Results: We included 162 patients, 50 of which presented with CNS involvement. Independent risk factors for CNS involvement were female sex (p = 0.04, OR 3.67, 95%CI 1.05–12.85), diabetes mellitus (p = 0.008, OR 5.08, 95%CI 1.519–17.04)), lymphocyte count (0.04, OR 0.23, 95%CI 0.05–0.97), platelets count (p = 0.001, OR 0.98, 95%CI 0.98–0.99) CRP value (p = 0.04, OR 1.007, 95%CI 1.000–1.015), and CK value (p = 0.004, OR 1.003, 95%CI 1.001–1.005). Obesity was a protective factor (p < 0.001, OR 0.57, 95%CI 0.016–0.20). New-onset CNS manifestations (p = 0.002, OR 14.48, 95%CI 2.58–81.23) were independent risk factors for in-hospital mortality. In-hospital mortality was higher in the new-onset CNS involvement group compared to patients without neurological involvement, 44% versus 7.1% (p < 0.001). Conclusions: CNS involvement in severe COVID-19 patients contributes to all causes of in-hospital mortality. There are several risk factors associated with new-onset CNS manifestations and preventing and controlling them could have an important impact on patients’ outcome.

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Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Cited by 2 publications

References 58 publications

Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights in a Brazilian Stroke Center

Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights in a Brazilian Stroke Center

Independent Risk Factors and Mortality Implications of De Novo Central Nervous System Involvement in Patients Hospitalized with Severe COVID-19: A Retrospective Cohort Study

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