Relationship between COVID-19 and stroke: Analysis of biochemical markers and mortality

Abstract

Background & Objective: We aimed to investigate the relationship between COVID-19 and stroke and analyze the biochemical markers that may affect or predict the mortality.

Methods: This study was conducted at Adana City Training and Research Hospital between March 1, 2020, and December 31, 2020. A total of 220 patients diagnosed with stroke and tested with Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for COVID-19 were included. The patients were divided into two main groups: cerebrovascular disease with negative RT-PCR (CVD) and cerebrovascular disease with positive RT-PCR (CVD+COVID-19).

Results: COVID-19 patients had a stroke on average at 8.49±6.8 (min:0- max:32) days. Admission to Intensive Care Unit (ICU) rate and mortality rate were significantly higher in CVD+COVID group (92.6% and 57.4% respectively). CVD+COVID-19 group had significantly higher levels of CRP, LDH, PT, INR, aPTT, fibrinogen, procalcitonin, D-Dimer, ferritin, and N/L ratio compared to the CVD group. In CVD-COVID-19 group the risk of admission to ICU increased 4.68 times. Also in this group NIHSS was found to be 20.57±6.19, albumin 33.12±5.23 g/L, and lymphocyte 1.10±0.76 10^3/µl. Higher lymphocyte and albumin and lower NIHSS values are protective effect on mortality and the optimum cut-off value of NIHSS for predicting mortality and admission to ICU are 18.5 (AUC=0.923) and 12.5 (AUC=0.954), respectively. Each 1 unit increase in the NIHSS value increases the risk of admission to ICU and mortality 1.86 times and 1.43 times, respectively.

Conclusion: This study revealed that stroke patients with COVID-19 had a higher risk for mortality and admission to ICU than non-COVID-19. The NIHSS value was a strong predictor for mortality.