Outcomes of COVID-19 Complications and their Possibilities as Potential Triggers of Stroke

Abstract

Introduction There is limited literature on coronavirus disease 2019 (COVID -19) complications such as thromboembolism, cardiac complications etc. as possible trigger for stroke. Hence, we aim to evaluate the prevalence and outcomes of COVID-19 related cardiovascular complications and secondary infection and their possibility as potential triggers for the stroke. Methods Data from observational studies describing the complications [acute cardiac injury (ACI), cardiac arrhythmias (CA), disseminated intravascular coagulation (DIC), septic shock, secondary infection] and outcomes of COVID‐19 hospitalized patients from December 1, 2019 to June 30, 2020, were extracted following PRISMA guidelines. Adverse outcomes defined as intensive care units, oxygen saturation less than 90%, invasive mechanical ventilation, severe disease, and in‐hospital mortality. The odds ratio and 95% confidence interval were obtained, and forest plots were created using random‐effects models. A short review of these complications as triggers of stroke was conducted. Results 16 studies with 3480 confirmed COVID-19 patients, prevalence of ACI [38%vs5.9%], CA [26%vs5.3%], DIC [4%vs0.74%], septic shock [18%vs0.36%], and infection [30%vs12.5%] was higher among patients with poor outcomes. In meta-analysis, ACI [aOR:9.93(95%CI:3.95–25.00], CA [7.52(3.29–17.18)], DIC [7.36(1.24–43.73)], septic shock [30.12(7.56–120.10)], and infection [10.41(4.47–24.27)] had higher odds of adverse outcomes. Patients hospitalized with acute ischemic stroke and intracerebral hemorrhage, had complications like pulmonary embolism, venous thromboembolism, DIC, etc. and had poor outcomes Conclusion The complications like acute cardiac injury, cardiac arrhythmias, DIC, septic shock, and secondary infection had poor outcomes. Patients with stroke were having history of these complications. Long term monitoring is required in such patients to prevent stroke and mitigate adverse outcomes.

Cardiac Injury in COVID-19: A Systematic Review of Relevant Meta-Analyses

“…The majority of studies (46 studies) reported the impact of CI on mortality (Table 1) [5,12,15,17,18,20,[22][23][24]29,[31][32][33]35,39,40,[42][43][44][45][46][47][48][49][50][51][52][53][56][57][58][59][60][61][62][63][64][65][66][67]70,73,74,[76][77][78].…”

“…Among the different statistical indices, OR was the most frequently used (29 studies) [4,5,12,21,22,[24][25][26][27][32][33][34]40,[42][43][44]47,48,50,52,58,59,[62][63][64]70,74,77,78], while RR and HR were used in 10 [15,18,23,39,45,48,56,57,72,73] and 6 studies [51,52,60,65,66,77], respectively. A minority of meta-analyses investigated pooled differences of cardiac biomarkers between severe vs non-severe disease or survivors vs non survivors (Table 1).…”

Main cardiac complications in patients with Post COVID-19 Syndrome

“…Entre las complicaciones cardiacas descritas tras una infección por Covid 19 se destaca la lesión cardiaca aguda como una de las más prevalentes, presentándose entre el 8 al 37 % de los pacientes. (6,7,8,9,10,11) Como resultado de esta lesión se describen distintos síntomas que pueden presentar estos pacientes siendo la arritmia uno de los más destacables al presentarse en un 10-16 %. (8,10,11) De la misma forma se puede evidenciar insuficiencia cardiaca en alrededor del 11 al 14 % de los pacientes (8,10,11) adicional a estos síntomas se puede presentar, aunque en menor proporción, coagulación intravascular disemina en menos del 2 % de los pacientes.…”

Ischemic and Hemorrhagic Cerebrovascular Events Related to COVID-19 Coagulopathy and Hypoxemia

“…To begin with, hypoxia per se promotes hypercoagulability, which leads to microthrombotic occlusion of the cerebral vessels and ischemic injury. Secondly, a SARS-CoV-2-related cytokine storm, and the resulting endothelial impairment, are also perceived as procoagulant factors [ 38 ].…”

“…This may imply that hypoxic-ischemic damage could be at least partially pre-existing in the investigated group of patients. On the contrary, certain cardiovascular conditions promote global hypoxemia and cerebral damage in COVID-19 patients [ 37 , 38 ].…”