Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study

Yanan Li, Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Man Li, Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Mengdie Wang, Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Yifan Zhou, Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Jiang Chang, Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ying Xian, Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA.
David Wang, Neurovascular Division, Department of Neurology, Barrow Neurological Institute/Saint Joseph Hospital Medical Center, Phoenix, Arizona, USA.Follow
Ling Mao, Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Huijuan Jin, Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China hubo@mail.hust.edu.cn jinhuijuan1983@163.com.
Bo Hu, Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China hubo@mail.hust.edu.cn jinhuijuan1983@163.com.

Document Type

Article

Abstract

BACKGROUND AND PURPOSE: COVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Apart from respiratory complications, acute cerebrovascular disease (CVD) has been observed in some patients with COVID-19. Therefore, we described the clinical characteristics, laboratory features, treatment and outcomes of CVD complicating SARS-CoV-2 infection. MATERIALS AND METHODS: Demographic and clinical characteristics, laboratory findings, treatments and clinical outcomes were collected and analysed. Clinical characteristics and laboratory findings of patients with COVID-19 with or without new-onset CVD were compared. RESULTS: Of 219 patients with COVID-19, 10 (4.6%) developed acute ischaemic stroke and 1 (0.5%) had intracerebral haemorrhage. COVID-19 with new onset of CVD were significantly older (75.7±10.8 years vs 52.1±15.3 years, p<0.001), more likely to present with severe COVID-19 (81.8% vs 39.9%, p<0.01) and were more likely to have cardiovascular risk factors, including hypertension, diabetes and medical history of CVD (all p<0.05). In addition, they were more likely to have increased inflammatory response and hypercoagulable state as reflected in C reactive protein (51.1 (1.3-127.9) vs 12.1 (0.1-212.0) mg/L, p<0.05) and D-dimer (6.9 (0.3-20.0) vs 0.5 (0.1-20.0) mg/L, p<0.001). Of 10 patients with ischemic stroke; 6 received antiplatelet treatment with aspirin or clopidogrel; and 3 of them died. The other four patients received anticoagulant treatment with enoxaparin and 2 of them died. As of 24 March 2020, six patients with CVD died (54.5%). CONCLUSION: Acute CVD is not uncommon in COVID-19. Our findings suggest that older patients with risk factors are more likely to develop CVD. The development of CVD is an important negative prognostic factor which requires further study to identify optimal management strategy to combat the COVID-19 outbreak.

Medical Subject Headings

Acute Disease; Aged; Aged, 80 and over; Anticoagulants (therapeutic use); Betacoronavirus (pathogenicity); COVID-19; Cerebrovascular Disorders (diagnosis, drug therapy, mortality, virology); China; Coronavirus Infections (diagnosis, mortality, therapy, virology); Female; Host-Pathogen Interactions; Humans; Male; Middle Aged; Pandemics; Platelet Aggregation Inhibitors (therapeutic use); Pneumonia, Viral (diagnosis, mortality, therapy, virology); Retrospective Studies; Risk Assessment; Risk Factors; SARS-CoV-2; Treatment Outcome

Publication Date

9-1-2020

Publication Title

Stroke and vascular neurology

E-ISSN

2059-8696

Volume

5

Issue

3

First Page

279

Last Page

284

PubMed ID

32616524

Digital Object Identifier (DOI)

10.1136/svn-2020-000431

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