[ad_1]
Asian ethnicity is strongly linked to COVID-related stroke, reveals an analysis of the activity of stroke centers in England and Scotland during the first wave of the coronavirus pandemic and accepted for publication in the Journal of Neurology Neurosurgery & Psychiatry.
Among patients with ischemic stroke, which is caused by a blocked artery, nearly 1 in 5 (20%) of those with COVID-19 infection when they had the stroke were Asian – more than double the percentage seen in patients with ischemic stroke without COVID -19.
The results indicate that ischemic strokes were also more extensive and severe and more likely to result in greater disability and death when associated with COVID-19.
Previous research has suggested that COVID-19 infection could make blood stickier and therefore more prone to clots, thereby potentially increasing the risk of stroke, but this finding has been undermined by the poor quality of evidence to date and by the reliance on comparisons with historical running data.
To get a clearer real-time picture of COVID-19’s potential impact on stroke risk, the researchers collected data for 1,470 strokes among patients admitted to 13 hospitals between March and July of this year, during the first wave of the coronavirus pandemic.
During this period, there were 86 strokes in patients with evidence of COVID-19 at the time: 81 of these strokes were ischemic (caused by blocked blood vessels); the rest were intracerebral hemorrhages (caused by the rupture of blood vessels).
Evidence of infection was determined by a positive coronavirus test within 4 days of admission or by a suspected COVID-19 upon admission and confirmed at any time during the next 10 days.
The characteristics of these “COVID” strokes were compared with 1384 (1193 ischemic and 191 intracerebral) among patients admitted during the same time period, but with no evidence of COVID-19.
Ethnicity was recorded in 86% of COVID cases and 78% of non-COVID cases. Among patients with ischemic stroke, nearly 1 in 5 (19%) of those with COVID-19 infection when they had stroke were Asian – more than double the percentage seen in patients with ischemic stroke without COVID-19 (7%) .
This rate was higher than that seen in people of Afro-Caribbean ethnicity. * Lead author of the study, Dr Richard Perry, comments, “Our study suggests that COVID-19 had a greater impact on strokes in the Asian community than other ethnic groups. We cannot tell from our data whether this is due to to the fact that Asians are more likely to catch COVID-19, but it seems unlikely that this is the only explanation.
“Evidence from Public Health England suggests that, in the UK, people of Afro-Caribbean descent are at a higher risk of contracting COVID-19, while those of Asian descent have only a slightly higher risk than whites. We suspect, therefore, that Asian people who contract COVID-19 may have a higher risk of stroke associated with COVID-19 than that seen in other ethnic groups. “
Ischemic strokes in COVID patients were about twice as likely to be caused by blockage of more than one large blood vessel in the brain (18% vs 8%) and to be more severe, with a mean stroke severity score (NIHSS ) of 8 against 5.
Levels of D-dimers, a protein marker for blood viscosity, were also higher in COVID-19-related strokes than in other strokes.
Ischemic strokes in COVID-19 patients were associated with more severe disability at discharge – mean disability score of 5 (out of a possible 6) – and death in hospital (20% vs 10%), even after accounting for other influential risk factors.
In the 45 COVID patients who had had an ischemic stroke and for whom both dates were recorded, the cardinal symptoms of COVID-19 occurred on average 6 days before the stroke.
Among the 3 patients who had a cerebral hemorrhage and for whom both dates were recorded, symptoms of COVID-19 occurred on average 4 days after the stroke. Although the numbers are small, this difference is significant, the researchers say.
They found no evidence to support previous suggestions that SARS-CoV-2, the virus responsible for COVID-19 infection, is associated with younger age or male sex in stroke patients.
The researchers acknowledge that one of the main limitations of their study was that they were only able to report investigations done as part of routine clinical care. But they included patients from 13 centers across the UK, so it may be more representative of existing studies from a single hospital system or city, they suggest.
“These findings … confirm that COVID-19 has an important influence on the onset, characteristics and outcome of acute ischemic stroke,” they write. It is not yet clear how the virus exerts its influence, but a single factor is unlikely to be responsible, they explain.
“We suggest that COVID-19 may cause the onset of ischemic stroke through a variety of thromboses. [clot forming] and inflammatory mechanisms, promoting the generation of thrombus [blood clot] in the heart or large vessels or by occlusion of the small vessels [blockage],” they write.
“Which of these mechanisms occurs in a given patient can be determined by that individual’s conventional vascular risk factors, such as atrial fibrillation [abnormal heart beat], atheroma of the great vessels [artery narrowing], hypertension [high blood pressure] or type 2 diabetes mellitus “.
And they conclude: “Our study still provides the strongest evidence that COVID-19-associated ischemic strokes are more severe and more likely to result in severe disability or death, although the outlook is not as bleak as previous studies have suggested.”
###
Revised externally? Yup
Type of evidence: case-control study
Subjects: stroke patients
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of press releases published on EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.
.
[ad_2]
Source link
