RISK FACTORS IN HOSPITALIZED PATIENTS WITH STROKE POSITIVE ON SARS-COV-2-INFECTION
Abstract
Numerous reports indicate an increased number of strokes in the period after the peak of Covid 19, describing the presence of "COVID strokes" in young individuals with atypical thromboembolic events. The main goal of this investigation was to assess/identify risk factors and coexisting comorbidities, in patients first time hospitalized for diagnosis of stroke at the Neuropsychiatric Department at the Public Health Institution (PHI) General Hospital Ohrid, positive for Sars-Cov-2- infection, from 6 months prior to the day of hospital admission in comparison to Sars-Cov-2 negative patients who met the same criteria. All 54 patients who met the criteria to be included in the study, after giving written consent, answered the modified European Stroke Awareness Questionnaire (SAQ). Traditional stroke risk factors were highly prevalent in our cohort (Sars-Cov-2-infected patients with stroke) with more than 80% of individuals having had at least 1 documented risk factor such as obesity (significantly more prevalent in our cohort), sedentary lifestyle and presence of two or three coexisting comorbidities such as hypertension, dyslipidemia, diabetes, or heart disease.The investigation will contribute to the development of new models and strategies for the prevention of stroke in patients with Covid-19- infection.
Key words: stroke, risk factors Covid-19, obesity, comorbidity
References
References
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2. Hoyer C, Ebert A, Huttner H.B et al. Acute stroke in times of the COVID-19 pandemic. Stroke. 2020; vol. 51, no. 7, pp. 2224– 2227.
3. Zhao J, Li H, Kung D, Fisher M, Shen Y, and Liu R. Impact of the COVID-19 epidemic on stroke care and potential solutions. Stroke. 2020; vol. 51, no. 7, pp. 1996–2001.
4. Diegoli H, Magalhães P.S.C, Martins S.C.O et al. Decrease in hospital admissions for transient ischemic attack, mild, and moderate stroke during the COVID-19 era.
Stroke.2020; vol. 51, no. 8, pp. 2315–2321.
5. Al Kasab S, Almallouhi E, Alawieh A. On behalf of STAR collaborators, et al. International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG. Journal of NeuroInterventional Surgery 2020;12:1039-1044.
6. Sharma M, Lioutas VA, Madsen T, Clark J, O’Sullivan J, Elkind MS, et al. Decline in
stroke alerts and hospitalisations during the COVID-19 pandemic. Stroke Vasc
Neurol. 2020;5:403–405.
7. Uchino K, Kolikonda MK, Brown D, Kovi S, Collins D, Khawaja Z, Buletko AB, Russman AN, Hussain MS. Decline in Stroke Presentations During COVID-19Surge. Stroke. 2020Aug;51(8):2544-47doi: 10.1161/STROKEAHA.120.030331.
8. Teo K, Leung WCY, Wong Y, Liu RKC, Chan AHY, Choi OMY, Kwok W, Leung K, Tse M, Cheung RTF, Tsang AC, Lau KK. Delays in Stroke Onset to Hospital Arrival Time During COVID-19. Stroke. 2020Jul;51(7):2228–2231. doi: 10.1161/STROKEAHA.120.030105.
9. Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19Pandemic. Stroke. 2020Sep;51(9):2664–2673. doi: 10.1161/STR.0000000000000347.
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11. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, De Leacy RA, Shigematsu T, Ladner TR, Yaeger KA, Skliut M, Weinberger J, Dangayach NS, Bederson JB, Tuhrim S, Fifi JT. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020 May 14;382(20):e60. doi: 10.1056/NEJMc2009787. Epub 2020 Apr 28. PMID: 32343504; PMCID: PMC7207073.
12. Morassi M, Bagatto D, Cobelli M, et al. Stroke in patients with SARSCoV-2 infection: case series. J Neurol. 2020;267(8):2185-2192.
13. Ahmadi Karvigh S, Vahabizad F, Banihashemi G, et al. Ischemic stroke in patients with COVID-19 disease: a report of 10 cases from Iran. Cerebrovasc Dis. 2021;50(2):239-244.
14. Adams HP Jr, Adams RJ, Brott T, del Zoppo GJ, Furlan A, Goldstein LB, Grubb RL, Higashida R, Kidwell C, Kwiatkowski TG, Marler JR, Hademenos GJ; Stroke Council of the American Stroke Association. Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003 Apr;34(4):1056-83. doi: 10.1161/01.STR.0000064841.47697.22. PMID: 12677087.
15. Hickey A, Mellon L, Williams D, Shelley E, Conroy RM. Does stroke health promotion increase awareness of appropriate behavioral response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response. Eur Stroke J. 2018 Jun;3(2):117-125. doi: 10.1177/2396987317753453. Epub 2018 Jan 11. PMID: 31008344; PMCID: PMC6460411.
16. Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases. 2015; May 16;3(5):418-29. doi: 10.12998/wjcc.v3.i5.418. PMID: 25984516; PMCID: PMC4419105.
17. Merkler AE, Parikh NS, Mir S, Gupta A, Kamel H, Lin E, Lantos J, Schenck EJ, Goyal P, Bruce SS, Kahan J, Lansdale KN, LeMoss NM, Murthy SB, Stieg PE, Fink ME, Iadecola C, Segal AZ, Cusick M, Campion TR Jr, Diaz I, Zhang C, Navi BB. Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza. JAMA Neurol. 2020 Jul 2;77(11):1–7. doi: 10.1001/jamaneurol.2020.2730. Epub ahead of print. PMID: 32614385; PMCID: PMC7333175.
18. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, Kneen R, Defres S, Sejvar J, Solomon T. Neurological associations of COVID-19. Lancet Neurol. 2020 Sep;19(9):767-783. doi: 10.1016/S1474-4422(20)30221-0. Epub 2020 Jul 2. PMID: 32622375; PMCID: PMC7332267.
19. Yaghi S, Ishida K, Torres J, Mac Grory B, Raz E, Humbert K, Henninger N, Trivedi T, Lillemoe K, Alam S, Sanger M, Kim S, Scher E, Dehkharghani S, Wachs M, Tanweer O, Volpicelli F, Bosworth B, Lord A, Frontera J. SARS-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020 Jul;51(7):2002-2011. doi: 10.1161/STROKEAHA.120.030335. Epub 2020 May 20. Erratum in: Stroke. 2020 Aug;51(8):e179. PMID: 32432996; PMCID: PMC7258764.
20. Qureshi Adnan I., Abd-Allah Foad. Management of acute ischemic in patients with COVID-19 infection: report of an international panel. Int. J. Stroke. 2020:1–15. doi: 10.1177/1747493020923234.
21. Gan Y, Wu J, Zhang S, Li L, Yin X, Gong Y, Herath C, Mkandawire N, Zhou Y, Song X, Zeng X, Li W, Liu Q, Shu C, Wang Z, Lu Z. Prevalence and risk factors associated with stroke in middle-aged and older Chinese: A community-based cross-sectional study. Sci Rep. 2017 Aug 25;7(1):9501. doi: 10.1038/s41598-017-09849-z. Erratum in: Sci Rep. 2018 Mar 9;8(1):4563. PMID: 28842623; PMCID: PMC5572736.
22. Hankey GJ. Potential new risk factors for ischemic stroke: what is their potential? Stroke 2006; 37: 2181-2188 PMID: 16809576 DOI: 10.1161/01.STR.0000229883.72010.e4
23. McGuinness B, Todd S, Passmore AP, Bullock R. Systematic review: Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. J Neurol Neurosurg Psychiatry 2008; 79: 4-5 PMID: 18079296
24. Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Trevano FQ, Grassi G, Sega R. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension 2007; 49: 1265-1270 PMID: 17452502 DOI: 10.1161/HYPERTENSIONAHA.107.088708
25. Mancia G. Prognostic value of long-term blood pressure variability: the evidence is growing. Hypertension 2011; 57: 141-143 PMID: 21199992 DOI: 10.1161/HYPERTENSIONAHA.110.165852
26. Eguchi K, Hoshide S, Schwartz JE, Shimada K, Kario K. Visitto-visit and ambulatory blood pressure variability as predictors of incident cardiovascular events in patients with hypertension. Am J Hypertens 2012; 25: 962-968 PMID: 22739805 DOI: 10.1038/ ajh.2012.75
27. Johansson JK, Niiranen TJ, Puukka PJ, Jula AM. Prognostic value of the variability in home-measured blood pressure and heart rate: the Finn-Home Study. Hypertension 2012; 59: 212-218 PMID: 22215704 DOI: 10.1161/HYPERTENSIONAHA.111.178657
28. Shimbo D, Newman JD, Aragaki AK, LaMonte MJ, Bavry AA, Allison M, Manson JE, Wassertheil-Smoller S. Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women’s Health Initiative. Hypertension 2012; 60: 625-630 PMID: 22753206 DOI: 10.1161/ HYPERTENSIONAHA.112.193094
29. Suchy-Dicey AM, Wallace ER, Mitchell SV, Aguilar M, Gottesman RF, Rice K, Kronmal R, Psaty BM, Longstreth WT. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens 2013; 26: 1210-1217 PMID: 23744496 DOI: 10.1093/ajh/hpt092
30. Kang J, Ko Y, Park JH, Kim WJ, Jang MS, Yang MH, Lee J, Lee J, Han MK, Gorelick PB, Bae HJ. Effect of blood pressure on 3-month functional outcome in the subacute stage of ischemic stroke. Neurology 2012; 79: 2018-2024 PMID: 23054228 DOI: 10.1212/ WNL.0b013e3182749eb8
31. Arboix A, GarcÃa-Eroles L, Massons J, Oliveres M, Targa C. Lacunar infarcts in patients aged 85 years and older. Acta Neurol Scand 2000; 101: 25-29 PMID: 10660148 DOI: 10.1034/ j.1600-0404.2000.00005.x
32. Arboix A, Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev 2010; 6: 150-161 PMID: 21804774 DOI: 10.2174/157340310791658730
33. Khoo CW, Lip GY. Clinical outcomes of acute stroke patients with atrial fibrillation. Expert Rev Cardiovasc Ther 2009; 7: 371-374 PMID: 19379061 DOI: 10.1586/erc.09.11
34. Iso H, Jacobs DR Jr, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med. 1989 Apr 6;320(14):904-10. doi: 10.1056/NEJM198904063201405. PMID: 2619783.
1. WHO COVID-19 Dashboard. Geneva: World Health Organization, 2020. ПриÑтапено на 15.1.2023: https://covid19.who.int/
2. Hoyer C, Ebert A, Huttner H.B et al. Acute stroke in times of the COVID-19 pandemic. Stroke. 2020; vol. 51, no. 7, pp. 2224– 2227.
3. Zhao J, Li H, Kung D, Fisher M, Shen Y, and Liu R. Impact of the COVID-19 epidemic on stroke care and potential solutions. Stroke. 2020; vol. 51, no. 7, pp. 1996–2001.
4. Diegoli H, Magalhães P.S.C, Martins S.C.O et al. Decrease in hospital admissions for transient ischemic attack, mild, and moderate stroke during the COVID-19 era.
Stroke.2020; vol. 51, no. 8, pp. 2315–2321.
5. Al Kasab S, Almallouhi E, Alawieh A. On behalf of STAR collaborators, et al. International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG. Journal of NeuroInterventional Surgery 2020;12:1039-1044.
6. Sharma M, Lioutas VA, Madsen T, Clark J, O’Sullivan J, Elkind MS, et al. Decline in
stroke alerts and hospitalisations during the COVID-19 pandemic. Stroke Vasc
Neurol. 2020;5:403–405.
7. Uchino K, Kolikonda MK, Brown D, Kovi S, Collins D, Khawaja Z, Buletko AB, Russman AN, Hussain MS. Decline in Stroke Presentations During COVID-19Surge. Stroke. 2020Aug;51(8):2544-47doi: 10.1161/STROKEAHA.120.030331.
8. Teo K, Leung WCY, Wong Y, Liu RKC, Chan AHY, Choi OMY, Kwok W, Leung K, Tse M, Cheung RTF, Tsang AC, Lau KK. Delays in Stroke Onset to Hospital Arrival Time During COVID-19. Stroke. 2020Jul;51(7):2228–2231. doi: 10.1161/STROKEAHA.120.030105.
9. Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19Pandemic. Stroke. 2020Sep;51(9):2664–2673. doi: 10.1161/STR.0000000000000347.
10. Aguiar de Sousa D, Sandset EC, Elkind MSV. The curious case of the missing strokes during theCOVID-19pandemic. Stroke.2020;51:1921–1923.doi:10.1161/STROKEAHA.120.030792
11. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, De Leacy RA, Shigematsu T, Ladner TR, Yaeger KA, Skliut M, Weinberger J, Dangayach NS, Bederson JB, Tuhrim S, Fifi JT. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med. 2020 May 14;382(20):e60. doi: 10.1056/NEJMc2009787. Epub 2020 Apr 28. PMID: 32343504; PMCID: PMC7207073.
12. Morassi M, Bagatto D, Cobelli M, et al. Stroke in patients with SARSCoV-2 infection: case series. J Neurol. 2020;267(8):2185-2192.
13. Ahmadi Karvigh S, Vahabizad F, Banihashemi G, et al. Ischemic stroke in patients with COVID-19 disease: a report of 10 cases from Iran. Cerebrovasc Dis. 2021;50(2):239-244.
14. Adams HP Jr, Adams RJ, Brott T, del Zoppo GJ, Furlan A, Goldstein LB, Grubb RL, Higashida R, Kidwell C, Kwiatkowski TG, Marler JR, Hademenos GJ; Stroke Council of the American Stroke Association. Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association. Stroke. 2003 Apr;34(4):1056-83. doi: 10.1161/01.STR.0000064841.47697.22. PMID: 12677087.
15. Hickey A, Mellon L, Williams D, Shelley E, Conroy RM. Does stroke health promotion increase awareness of appropriate behavioral response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response. Eur Stroke J. 2018 Jun;3(2):117-125. doi: 10.1177/2396987317753453. Epub 2018 Jan 11. PMID: 31008344; PMCID: PMC6460411.
16. Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases. 2015; May 16;3(5):418-29. doi: 10.12998/wjcc.v3.i5.418. PMID: 25984516; PMCID: PMC4419105.
17. Merkler AE, Parikh NS, Mir S, Gupta A, Kamel H, Lin E, Lantos J, Schenck EJ, Goyal P, Bruce SS, Kahan J, Lansdale KN, LeMoss NM, Murthy SB, Stieg PE, Fink ME, Iadecola C, Segal AZ, Cusick M, Campion TR Jr, Diaz I, Zhang C, Navi BB. Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza. JAMA Neurol. 2020 Jul 2;77(11):1–7. doi: 10.1001/jamaneurol.2020.2730. Epub ahead of print. PMID: 32614385; PMCID: PMC7333175.
18. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, Kneen R, Defres S, Sejvar J, Solomon T. Neurological associations of COVID-19. Lancet Neurol. 2020 Sep;19(9):767-783. doi: 10.1016/S1474-4422(20)30221-0. Epub 2020 Jul 2. PMID: 32622375; PMCID: PMC7332267.
19. Yaghi S, Ishida K, Torres J, Mac Grory B, Raz E, Humbert K, Henninger N, Trivedi T, Lillemoe K, Alam S, Sanger M, Kim S, Scher E, Dehkharghani S, Wachs M, Tanweer O, Volpicelli F, Bosworth B, Lord A, Frontera J. SARS-CoV-2 and Stroke in a New York Healthcare System. Stroke. 2020 Jul;51(7):2002-2011. doi: 10.1161/STROKEAHA.120.030335. Epub 2020 May 20. Erratum in: Stroke. 2020 Aug;51(8):e179. PMID: 32432996; PMCID: PMC7258764.
20. Qureshi Adnan I., Abd-Allah Foad. Management of acute ischemic in patients with COVID-19 infection: report of an international panel. Int. J. Stroke. 2020:1–15. doi: 10.1177/1747493020923234.
21. Gan Y, Wu J, Zhang S, Li L, Yin X, Gong Y, Herath C, Mkandawire N, Zhou Y, Song X, Zeng X, Li W, Liu Q, Shu C, Wang Z, Lu Z. Prevalence and risk factors associated with stroke in middle-aged and older Chinese: A community-based cross-sectional study. Sci Rep. 2017 Aug 25;7(1):9501. doi: 10.1038/s41598-017-09849-z. Erratum in: Sci Rep. 2018 Mar 9;8(1):4563. PMID: 28842623; PMCID: PMC5572736.
22. Hankey GJ. Potential new risk factors for ischemic stroke: what is their potential? Stroke 2006; 37: 2181-2188 PMID: 16809576 DOI: 10.1161/01.STR.0000229883.72010.e4
23. McGuinness B, Todd S, Passmore AP, Bullock R. Systematic review: Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. J Neurol Neurosurg Psychiatry 2008; 79: 4-5 PMID: 18079296
24. Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Trevano FQ, Grassi G, Sega R. Long-term prognostic value of blood pressure variability in the general population: results of the Pressioni Arteriose Monitorate e Loro Associazioni Study. Hypertension 2007; 49: 1265-1270 PMID: 17452502 DOI: 10.1161/HYPERTENSIONAHA.107.088708
25. Mancia G. Prognostic value of long-term blood pressure variability: the evidence is growing. Hypertension 2011; 57: 141-143 PMID: 21199992 DOI: 10.1161/HYPERTENSIONAHA.110.165852
26. Eguchi K, Hoshide S, Schwartz JE, Shimada K, Kario K. Visitto-visit and ambulatory blood pressure variability as predictors of incident cardiovascular events in patients with hypertension. Am J Hypertens 2012; 25: 962-968 PMID: 22739805 DOI: 10.1038/ ajh.2012.75
27. Johansson JK, Niiranen TJ, Puukka PJ, Jula AM. Prognostic value of the variability in home-measured blood pressure and heart rate: the Finn-Home Study. Hypertension 2012; 59: 212-218 PMID: 22215704 DOI: 10.1161/HYPERTENSIONAHA.111.178657
28. Shimbo D, Newman JD, Aragaki AK, LaMonte MJ, Bavry AA, Allison M, Manson JE, Wassertheil-Smoller S. Association between annual visit-to-visit blood pressure variability and stroke in postmenopausal women: data from the Women’s Health Initiative. Hypertension 2012; 60: 625-630 PMID: 22753206 DOI: 10.1161/ HYPERTENSIONAHA.112.193094
29. Suchy-Dicey AM, Wallace ER, Mitchell SV, Aguilar M, Gottesman RF, Rice K, Kronmal R, Psaty BM, Longstreth WT. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens 2013; 26: 1210-1217 PMID: 23744496 DOI: 10.1093/ajh/hpt092
30. Kang J, Ko Y, Park JH, Kim WJ, Jang MS, Yang MH, Lee J, Lee J, Han MK, Gorelick PB, Bae HJ. Effect of blood pressure on 3-month functional outcome in the subacute stage of ischemic stroke. Neurology 2012; 79: 2018-2024 PMID: 23054228 DOI: 10.1212/ WNL.0b013e3182749eb8
31. Arboix A, GarcÃa-Eroles L, Massons J, Oliveres M, Targa C. Lacunar infarcts in patients aged 85 years and older. Acta Neurol Scand 2000; 101: 25-29 PMID: 10660148 DOI: 10.1034/ j.1600-0404.2000.00005.x
32. Arboix A, Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev 2010; 6: 150-161 PMID: 21804774 DOI: 10.2174/157340310791658730
33. Khoo CW, Lip GY. Clinical outcomes of acute stroke patients with atrial fibrillation. Expert Rev Cardiovasc Ther 2009; 7: 371-374 PMID: 19379061 DOI: 10.1586/erc.09.11
34. Iso H, Jacobs DR Jr, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med. 1989 Apr 6;320(14):904-10. doi: 10.1056/NEJM198904063201405. PMID: 2619783.
Published
2023-11-05
How to Cite
PETROVSKA, Monika et al.
RISK FACTORS IN HOSPITALIZED PATIENTS WITH STROKE POSITIVE ON SARS-COV-2-INFECTION.
Journal of Morphological Sciences, [S.l.], v. 6, n. 2, p. 189-197, nov. 2023.
ISSN 2545-4706.
Available at: <https://jms.mk/jms/article/view/vol6no2-25>. Date accessed: 22 dec. 2024.
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