Stroke Features, Risk Factors, and Pathophysiology in SARS-CoV-2-Infected Patients

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

doi:10.1016/j.mayocpiqo.2022.01.003

Stroke Features, Risk Factors, and Pathophysiology in SARS-CoV-2-Infected Patients

Mayo Clin Proc Innov Qual Outcomes. 2022 Apr;6(2):156-165. doi: 10.1016/j.mayocpiqo.2022.01.003. Epub 2022 Jan 21.

Authors

Amir A Mbonde¹, Cumara B O'Carroll¹, Marie F Grill¹, Nan Zhang², Richard Butterfield², Bart M Demaerschalk¹

Affiliations

¹ Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZ.
² Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ.

Abstract

Objective: To provide a comprehensive description of stroke characteristics, risk factors, laboratory parameters, and treatment in a series of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients admitted to Mayo Clinic hospitals in Rochester, Minnesota; Jacksonville, Florida; and Phoenix, Arizona, as well as 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 September 8, 2019, and December 31, 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 of 30 individuals and hemorrhagic in 4 of 30. Traditional risk factors were common including hypertension (24 of 30), hyperlipidemia (18 of 30), smoking history (13 of 30), diabetes (11 of 30), and atrial fibrillation (8 of 30). The most common ischemic stroke mechanisms were cardioembolism (9 of 26) and cryptogenic (9 of 26). Intravenous alteplase and mechanical thrombectomy were administered to 2 of 26 and 1 of 26, respectively. The median (interquartile range) serum C-reactive protein, interleukin-6, D-dimer, fibrinogen, and ferritin levels were 66 (21-210) mg/L, 116 (8-400) pg/mL, 1267 (556-4510) ng/mL, 711 (263-772) mg/dL, and 407 (170-757) mcg/L, respectively, which were elevated in individuals with available results.

Conclusion: The high prevalence of vascular risk factors and concurrent elevation of proinflammatory and procoagulation biomarkers suggest 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 cell; EMR, electronic medical record; IQR, interquartile range; RAAS, renin-angiotensin-aldosterone system; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.