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Abstract
Background and purpose COVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Apart from respiratory complications, acute cerebrovascular disease (CVD) has been observed in some patients with COVID-19. Therefore, we described the clinical characteristics, laboratory features, treatment and outcomes of CVD complicating SARS-CoV-2 infection.
Materials and methods Demographic and clinical characteristics, laboratory findings, treatments and clinical outcomes were collected and analysed. Clinical characteristics and laboratory findings of patients with COVID-19 with or without new-onset CVD were compared.
Results Of 219 patients with COVID-19, 10 (4.6%) developed acute ischaemic stroke and 1 (0.5%) had intracerebral haemorrhage. COVID-19 with new onset of CVD were significantly older (75.7±10.8 years vs 52.1±15.3 years, p<0.001), more likely to present with severe COVID-19 (81.8% vs 39.9%, p<0.01) and were more likely to have cardiovascular risk factors, including hypertension, diabetes and medical history of CVD (all p<0.05). In addition, they were more likely to have increased inflammatory response and hypercoagulable state as reflected in C reactive protein (51.1 (1.3–127.9) vs 12.1 (0.1–212.0) mg/L, p<0.05) and D-dimer (6.9 (0.3–20.0) vs 0.5 (0.1–20.0) mg/L, p<0.001). Of 10 patients with ischemic stroke; 6 received antiplatelet treatment with aspirin or clopidogrel; and 3 of them died. The other four patients received anticoagulant treatment with enoxaparin and 2 of them died. As of 24 March 2020, six patients with CVD died (54.5%).
Conclusion Acute CVD is not uncommon in COVID-19. Our findings suggest that older patients with risk factors are more likely to develop CVD. The development of CVD is an important negative prognostic factor which requires further study to identify optimal management strategy to combat the COVID-19 outbreak.
- stroke
- Cerebrovascular disease
- COVID-19
- Anticoagulation therapy
- Thromboembolic events
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Footnotes
YL, ML, MW, YZ and JC are joint first authors.
YL, ML, MW, YZ and JC contributed equally.
Contributors Concept and design: BH, YL; acquisition, analysis or interpretation of data: JC, HJ, ML, MW, YZ, YX; drafting of the manuscript: BH, YL, ML, HJ, MW, JC, YZ, YX; critical revision of the manuscript for important intellectual content: BH; statistical analysis: JC, YL; obtained funding: BH; administrative, technical or material support: BH, YL, HJ, ML, MW, YZ, YX; supervision: BH.
Funding This study was funded by the National Key Research and Development Program of China (number 2018YFC1312200 to BH) and the National Natural Science Foundation of China (number 81820108010 to BH).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, BH (Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. hubo@mail.hust.edu.cn), upon reasonable request.