An Increased Risk for Ischemic Stroke in the Short-Term Period following COVID-19 Infection: A Nationwide Population-Based Study

Abstract

<b><i>Introduction:</i></b> The association disclosed between coronavirus disease 2019 (COVID-19) infection and ischemic stroke (IS) raises concern. The exact risk periods, which were not consistent between studies, require further investigation. <b><i>Methods:</i></b> We linked two national databases: the COVID-19 database and the Israeli National Stroke Registry. The self-controlled case series method was used to estimate the association between COVID-19 infection and a first IS. The study population included all Israeli residents who had both a first IS event and a first COVID-19 diagnosis during 2020. The date of the PCR test served to define the day of exposure, and the 28 days following it were categorized into three risk periods: days 1–7, 8–14, and 15–28. A relative incidence (RI) with a 95% confidence interval (95% CI) was calculated based on the incidence rate of events in a post-exposure period, compared to the incidence rate in a control period. <b><i>Results:</i></b> From January 1, 2020, to December 31, 2020, 308,015 Israelis aged 18+ were diagnosed with COVID-19 and 9,535 were diagnosed with a first IS. Linking the two databases, 555 persons had both diagnoses during 2020. The mean age of the study population was 71.5 ± 13.7, 55.1% were males, 77.8% had hypertension, 73.7% had hyperlipidemia, 51.9% had diabetes, and 28.5% had ischemic heart disease. Comparing the risk period and the control period, we found a very similar distribution of the cardiovascular risk factors. The risk for an acute IS was 3.3-fold higher in the first week following COVID-19 diagnosis, compared with a control period (RI = 3.3; 95% CI: 2.3–4.6). The RI among males (RI = 4.5; 95% CI: 2.9–6.8) was 2.2-fold higher compared to females. The increased risk did not last beyond the first week following exposure. <b><i>Conclusion:</i></b> Physicians should be aware of the elevated risk for IS among patients experiencing COVID-19, particularly among men with high burden of cardiovascular risk factors.

Single-cell RNA sequencing and multiple bioinformatics methods to identify the immunity and ferroptosis-related biomarkers of SARS-CoV-2 infections to ischemic stroke

“…In addition, SARS-CoV-2 infection significantly increases mortality in patients with idiopathic pulmonary fibrosis [ 5 ]. A recent study reported that COVID-19 may increase the short-term incidence of ischemic stroke [ 6 ]. Other extrapulmonary manifestations include diarrhoea, lymphopenia, thrombocytopenia, impaired hepatic and renal function, rhabdomyolysis, meningoencephalitis, stroke, convulsions, cardiac arrhythmia or cardiac block, pancreatitis, Kawasaki disease such as multisystemic vasculitis, skin rash, thromboembolism, and acute thyroiditis [ 7 ].…”