Ischemic stroke in COVID-19-positive patients: an overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist

Zakeri, Amanda; Jadhav, Ashutosh P.; Sullenger, Bruce A.; Nimjee, Shahid M

doi:10.1136/neurintsurg-2020-016794

Cited by 83 publications

(72 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, the prognostic value of D-dimer in COVID-19 could differ for COVID-19 patients presenting with AIS, in whom D-dimer levels may be independently elevated. Our study confirmed that D-dimer levels at admission were elevated among COVID-19 patients [0.95 (0.56-1.83) µg/ml FEU] beyond normal range (<0.5 µg/ml FEU) and greater elevations were observed among COVID-19 patients presenting with AIS [1.42 (0.76-3.96) µg/ml FEU] (15,16).…”

Section: Discussionsupporting

confidence: 83%

Predicting In-hospital Mortality Using D-Dimer in COVID-19 Patients With Acute Ischemic Stroke

et al. 2021

View full text Add to dashboard Cite

Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulopathy, and D-dimer levels have been used to predict disease severity. However, the role of D-dimer in predicting mortality in COVID-19 patients with acute ischemic stroke (AIS) remains incompletely characterized.Methods: We conducted a retrospective cohort study using the Optum® de-identified COVID-19 Electronic Health Record dataset. Patients were included if they were 18 or older, had been hospitalized within 7 days of confirmed COVID-19 positivity from March 1, 2020 to November 30, 2020. We determined the optimal threshold of D-dimer to predict in-hospital mortality and compared risks of in-hospital mortality between patients with D-dimer levels below and above the cutoff. Risk ratios (RRs) were estimated adjusting for baseline characteristics and clinical variables.Results: Among 15,250 patients hospitalized with COVID-19 positivity, 285 presented with AIS at admission (2%). Patients with AIS were older [70 (60–79) vs. 64 (52–75), p < 0.001] and had greater D-dimer levels at admission [1.42 (0.76–3.96) vs. 0.94 (0.55–1.81) μg/ml FEU, p < 0.001]. Peak D-dimer level was a good predictor of in-hospital mortality among all patients [c-statistic 0.774 (95% CI 0.764–0.784)] and among patients with AIS [c-statistic 0.751 (95% CI 0.691–0.810)]. Among AIS patients, the optimum cutoff was identified at 5.15 μg/ml FEU with 73% sensitivity and 69% specificity. Elevated peak D-dimer level above this cut-off was associated with almost 3 times increased mortality [adjusted RR 2.89 (95% CI 1.87–4.47), p < 0.001].Conclusions: COVID-19 patients with AIS present with greater D-dimer levels. Thresholds for outcomes prognostication should be higher in this population.

show abstract

Section: Discussionsupporting

confidence: 83%

Predicting In-hospital Mortality Using D-Dimer in COVID-19 Patients With Acute Ischemic Stroke

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This agrees with previous studies in which COVID-19 was identified as an independent risk factor for stroke. 18,19 The varied multisystemic manifestations of our patients may be related to the wide distribution of the preferred SARS-CoV-2 host receptor, angiotensin-converting enzyme † Based on WHO definition of severity 1 : mild, symptomatic patients with no evidence of viral pneumonia or hypoxia; moderate, SpO2 $ 90%, fever, cough, dyspnea, fast breathing (clinical signs of pneumonia) but no signs of severe pneumonia; severe, SpO2 , 90%, adolescent or adult with clinical signs of pneumonia (fever, cough, dyspnea, fast breathing), severe respiratory distress.…”

Section: Discussionmentioning

confidence: 99%

Post-Discharge Symptoms among Hospitalized COVID-19 Patients in Nigeria: A Single-Center Study

Ogoina

James

Ogoinja

2021

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

There is a paucity of studies on post-acute COVID-19 syndrome (PCS) among hospitalized COVID-19 survivors from Nigeria. We describe the frequency, types, and duration of post-discharge symptoms suggestive of PCS among previously hospitalized COVID-19 patients in a treatment center in Nigeria. We conducted a retrospective review of admission and post-discharge follow-up medical records of COVID-19 survivors admitted between April and December 2020. A standardized checklist was used to document post-discharge symptoms. PCS was defined as persisting or new post-discharge symptoms lasting at least 3 weeks after initial COVID-19 symptoms. The relationship between study variables and development of PCS was ascertained by univariate analysis. Thirty of 51 previously hospitalized COVID-19 patients (median age, 46 years; male, 66.7%) were studied. Seventeen (56.7%) of the 30 patients developed features suggestive of PCS. Approximately three post-discharge symptoms were reported per patient over a follow-up period of ranging from 3 weeks to 9 months after initial COVID-19 symptoms. Cough, fatigue, and dyspnea were the most common post-discharge symptoms reported. A few patients had symptoms suggestive of thrombosis and COVID-19 reinfection. Among all study variables, baseline COVID-19 severity was the only significant variable associated with the development of PCS. PCS is common in our setting and is characterized by multisystemic signs and symptoms that require vigilance by clinicians for appropriate diagnosis and treatment. Long-term multicenter prospective studies are needed to characterize fully the burden of PCS among COVID-19 survivors in Nigeria.

show abstract

“…Generally, and for the exception of graft thrombosis, causes of ALI are either arterial embolism (30-46%) or thrombosis (20-40%). Cardiac or aortic embolization, hypercoagulable states, and iatrogenic complications from endovascular procedures are also associated with a decrease in limb perfusion leading to ALI [12].…”

Section: Discussionmentioning

confidence: 99%

Acute Limb Ischemia as the Initial Severe Presentation in COVID-19

Horani¹,

Kaur²,

Patel³

et al. 2021

Cureus

View full text Add to dashboard Cite

Coronavirus disease 2019 , caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by an overwhelming inflammatory response in a subset of patients, resulting in respiratory compromise, multiorgan failure, and death. A common complication seen in patients hospitalized with COVID-19 infections is the development of venous and arterial thromboemboli. This occurs especially in patients who suffer from severe respiratory or systemic manifestations on the COVID-19 spectrum of disease. We present a case of acute limb ischemia as the initial presentation in a patient who tested positive for COVID-19.

show abstract

Ischemic stroke in COVID-19-positive patients: an overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist

Cited by 83 publications

References 58 publications

Predicting In-hospital Mortality Using D-Dimer in COVID-19 Patients With Acute Ischemic Stroke

Predicting In-hospital Mortality Using D-Dimer in COVID-19 Patients With Acute Ischemic Stroke

Post-Discharge Symptoms among Hospitalized COVID-19 Patients in Nigeria: A Single-Center Study

Acute Limb Ischemia as the Initial Severe Presentation in COVID-19

Contact Info

Product

Resources

About