Objective: Coronavirus disease 2019 (COVID-19) seems more related to stroke than other respiratory viruses. Acute stroke has become increasingly conspicuous during a typical COVID-19 infection. In the present study, we aim to evaluate stroke characteristics in the context of COVID-19 infection.
Material and Methods: We conducted a single-center prospective study and evaluated characteristics of stroke patients who had concomitant definite COVID-19 (dCOV) (n = 24), suspected COVID-19 (sCOV) (n = 31), and no COVID-19 (CG) (n = 19). Then we classified all participants into two groups according to modified Rankin Scale (mRS) scores (0-2 indicating good outcome, 3-6 indicating poor outcome). A logistic regression analysis and a Receiver Operating Characteristic area under the curve were performed to evaluate the variables that predict a poor prognosis.
Results: Just over half of the patients in the dCOV were admitted with stroke symptoms and diagnosed with COVID-19 at admission, and nearly half of the patients initially had a COVID-19 diagnosis. They had developed stroke after a gap of 4-21 days. Ischemic stroke was the most common stroke subtype in dCOV. The dCOV had higher mRS indicating poor outcomes. Patients with poor outcomes had higher levels of d-dimer, neutrophil-to-lymphocyte ratio (NLR), procalcitonin, and AST. NLR predicts reliably poor outcome, overall with an 86.0% accuracy.
Conclusions: COVID-19 related stroke is associated with high inflammatory biomarkers, poor outcome, and high mortality. NLR is a potential, cost-effective, and easy-to-use marker of poor prognosis in COVID-19 related stroke.
Key words: COVID-19, stroke, cerebrovascular disease, neutrophil-to-lymphocyte ratio, prognosis
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