Miyazaki Kazuki, Kanno Hiroshi, Yamada Sachiko, Sagehashi Yuuki, Matsumoto Shutaro, Takahashi Satoru, Kim Yongson, Namiki Keiko, Fujii Satoshi
Department of Neurosugery, Asahi Hospital, Tokyo, JPN.
Department of Neurosurgery, Asahi Hospital, Tokyo, JPN.
Cureus. 2024 Feb 23;16(2):e54760. doi: 10.7759/cureus.54760. eCollection 2024 Feb.
In December 2019, COVID-19 spread rapidly across the globe. Throughout the pandemic, SARS-CoV-2 repeatedly mutated, transitioning from the alpha variant to the omicron variant. The severity and mortality of COVID-19 have been linked to age, sex, and the presence of underlying diseases (respiratory, cerebrovascular, cardiovascular, metabolic, and immune diseases, as well as cancer). The clinical features of patients infected with COVID-19 following a stroke, however, are fully unknown. Therefore, it is significant to explore the appropriate treatment for these patients based on their clinical features.
Of the 6175 patients who visited Asahi Hospital (Tokyo, Japan) between November 2022 and February 2023, 206 were admitted. Of these 206 patients, the 44 that contracted COVID-19 while hospitalized for strokes were retrospectively analyzed.
Six (13.6%) of these patients died; four expired due to coagulopathy associated with ischemic heart failure and recurrent ischemic cerebrovascular disease. The mean D-dimer level increased to 3.53 in the deceased patients, while it was 1.64 in all patients. The platelet count was low in three of the deceased patients, while it was high in two patients. The severity of COVID-19 was significantly correlated with a high modified Rankin Scale (mRS) score and a high National Institute of Health Stroke Scale (NIHSS) score. The timing of vaccination is inversely correlated with COVID-19 severity.
Patients with COVID-19 after a stroke have high mortality rates due to coagulopathy. Stroke patients with high mRS scores and high NIHSS scores are more likely to develop severe COVID-19. Anticoagulant therapy should be administered to COVID-19 patients with high mRS scores following a stroke.
2019年12月，新型冠状病毒肺炎（COVID-19）在全球迅速传播。在整个疫情期间，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）不断变异，从阿尔法变异株演变为奥密克戎变异株。COVID-19的严重程度和死亡率与年龄、性别以及基础疾病（呼吸系统疾病、脑血管疾病、心血管疾病、代谢性疾病、免疫性疾病以及癌症）的存在有关。然而，卒中后感染COVID-19患者的临床特征尚完全未知。因此，根据这些患者的临床特征探索合适的治疗方法具有重要意义。
在2022年11月至2023年2月期间前往朝日医院（日本东京）就诊的6175例患者中，有206例入院。在这206例患者中，对44例在因卒中住院期间感染COVID-19的患者进行了回顾性分析。
这些患者中有6例（13.6%）死亡；4例死于与缺血性心力衰竭和复发性缺血性脑血管疾病相关的凝血病。死亡患者的平均D-二聚体水平升至3.53，而所有患者的平均D-二聚体水平为1.64。3例死亡患者的血小板计数较低，2例患者的血小板计数较高。COVID-19的严重程度与改良Rankin量表（mRS）评分高和美国国立卫生研究院卒中量表（NIHSS）评分高显著相关。接种疫苗的时间与COVID-19严重程度呈负相关。
卒中后感染COVID-19的患者因凝血病死亡率较高。mRS评分高和NIHSS评分高的卒中患者更易发生重症COVID-19。对于卒中后mRS评分高的COVID-19患者应给予抗凝治疗。
