Roman-Filip Corina, Catană Vlădoiu Maria-Gabriela, Văleanu Mădălina, Mihăilă Romeo-Gabriel
Neurology Department, Emergency County Clinical Hospital Sibiu, Corneliu Coposu bvd, Sibiu 550245, Romania.
Faculty of Medicine, Lucian Blaga University of Sibiu, Izvorului Street, Sibiu 550169, Romania.
Emerg Med Int. 2023 May 22;2023:5931502. doi: 10.1155/2023/5931502. eCollection 2023.
Stroke is the main cause of disability and exitus worldwide. The prediction of mortality of this pathology represents a major challenge. More than that, the infection with the SARS-CoV-2 virus is a challenge for every clinician worldwide, and hypercoagulability is one of its biggest concerns that can lead to stroke.
Our aim was to develop a severity stroke index for both SARS-CoV-2 stroke patients and noninfected stroke patients which we hope to be helpful in patient's management.
We conducted a prospective study during January 2021-June 2021 which included 80 patients who suffered an ischemic stroke, 40 of which had both stroke and SARS-CoV-2 infection. We have established a panel of biomarkers including CRP, IL-6, fibrinogen, ESR, D-dimer, leucocytes, lymphocytes, and NLR and compared the results of our two cohorts.
SARS-CoV-2 stroke patients have experienced elevated levels of biomarkers that rise in inflammation such as hs-CRP, IL-6, and D-dimer, comparing to noninfected stroke patients. Also, the probability of exitus in SARS-CoV-2 patients is 4.2 times higher than in noninfected subjects. With regard to stroke severity, we have concluded that a NIHSS score higher than 15 points considerably influences the death rate, the probability of exitus being 9.16 times higher than in NIHSS score lower than 15.
Based on our result, we have established a severity score index which includes NIHSS score, age, gender, the presence/absence of COVID-19 infection, and the following biomarkers: hs-PCR, IL-6, D-dimer, fibrinogen, and ESR, which can be used as a tool to guide patient's management.
中风是全球致残和死亡的主要原因。预测这种疾病的死亡率是一项重大挑战。不仅如此，感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒对全球每位临床医生来说都是一项挑战，而高凝状态是其最令人担忧的问题之一，可能导致中风。
我们的目标是为感染SARS-CoV-2的中风患者和未感染的中风患者制定一个中风严重程度指数，希望有助于患者的管理。
我们在2021年1月至2021年6月期间进行了一项前瞻性研究，纳入了80例缺血性中风患者，其中40例同时患有中风和SARS-CoV-2感染。我们建立了一个生物标志物组，包括C反应蛋白（CRP）、白细胞介素-6（IL-6）、纤维蛋白原、红细胞沉降率（ESR）、D-二聚体、白细胞、淋巴细胞和中性粒细胞与淋巴细胞比值（NLR），并比较了两个队列的结果。
与未感染的中风患者相比，感染SARS-CoV-2的中风患者体内炎症相关生物标志物水平升高，如高敏CRP、IL-6和D-二聚体。此外，感染SARS-CoV-2的患者死亡概率比未感染的患者高4.2倍。关于中风严重程度，我们得出结论，美国国立卫生研究院卒中量表（NIHSS）评分高于15分对死亡率有显著影响，死亡概率比NIHSS评分低于15分的患者高9.16倍。
基于我们的结果，我们建立了一个严重程度评分指数，包括NIHSS评分、年龄、性别、是否感染新型冠状病毒肺炎（COVID-19）以及以下生物标志物：高敏PCR、IL-6、D-二聚体、纤维蛋白原和ESR，可作为指导患者管理的工具。
