1. Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association.
- Author
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Janes, Francesco, Sozio, Emanuela, Gigli, Gian Luigi, Ripoli, Andrea, Sbrana, Francesco, Kuris, Fedra, Nesi, Lorenzo, Semenzin, Tosca, Bertolino, Giacomo, Deana, Cristian, Bagatto, Daniele, Ciardi, Chiara, Fabris, Martina, Merlino, Giovanni, Bax, Francesco, Nilo, Annacarmen, Pez, Sara, Valente, Mariarosaria, and Tascini, Carlo
- Subjects
OBESITY paradox ,DISEASE risk factors ,ISCHEMIC stroke ,COVID-19 ,MYOCARDIAL ischemia ,STROKE - Abstract
Background and purpose: Stroke has been described as a COVID-19 complication. However, its occurrence rate, risk factors, and causal relationships are still not well established. Methods: We describe the characteristics of confirmed COVID-19-related strokes among all cases of COVID-19 hospitalized in our health network, from November 1, 2020 to April 30, 2021. Risk factor analysis has been conducted for ischemic stroke (IS), which represents 92% of all confirmed cases of Covid-19-related strokes, and a "causal attribution to infection" classification is provided. Results: In all, 62/4105 hospitalized COVID-19 patients had an acute stroke (1.51%). Severe COVID-19 (OR 2.27--CI 1.06-4.77; p = 0.032), atrial fibrillation (OR 3.65--CI 1.63-7.98; p = 0.001), and ischemic heart disease (OR 4.590--CI 1.714-12.137; p = 0.002) proved to be independent risk factors for IS, while obesity was a protective factor (OR 0.90--CI 0.82-0.97; p = 0.012). COVID-19 had a causal role in 32.1% of IS cases, was a relevant cofactor in 28.6% of cases of IS, and was a possible trigger in 39.3% of events. Conclusion: Our stroke occurrence rate is consistent with other populationbased reports (range 0.34-2.7%). Prespecified peculiar clinical and radiological features allow the distinction between "IS caused by COVID-19" and "IS triggered by COVID-19." Clinical history of vascular diseases and risk factors is crucial in determining the risk of IS in patients with COVID-19. However, the protective effect of a BMI > 30 kg/m2 seems to suggest an obesity paradox. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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