COVID-ASSOCIATED STROKE: RISK FACTORS AND POLYMORBIDITY OF THE LESION

Objective: To determine the incidence and risk factors for stroke in patients infected with SARS-CoV-2. Design and method: The results of pathological examinations of 1000 patients aged 36 to 97 years with a positive PCR and clinical presentation were analyzed. Patients were admitted to hospital on days 1-21 (5.5) from the onset of the disease. Strokes were diagnosed in 152 out of 1000 people (15.2%): 84 women (55.3%) and 68 men (44.7%). All 152 patients had arterial hypertension; 111 (73%) -coronary heart disease, of which 24 (21.6%) -myocardial infarctions (MI). Type 2 diabetes mellitus was suffered by 61 (40.1%) people; 88 (57.9%) had a history of strokes. All patients underwent computed tomography (CT) of the brain and lungs. C-reactive protein (CRP), ferritin, fibrinogen, D-dimer were determined. Results: The incidence of strokes in young people (group 1) was 0.2%; middle-aged (group 2) - 1.3%; elderly (group 3) - 5.4%; old age (group 4) - 8.3%. Ischemic strokes were detected in 128 people (84.2%), hemorrhagic strokes - in 24 (15.8%). Distribution by gender (women/men) and age showed that in group 1 this ratio was 0/1.3%; in group 2 – 2.6/5.9%; in group 3 – 17.8/17.8%; in group 4 – 34.9/19.7%. Diffuse alveolar damage (DAD)were detected in 139 (91.4%) people; of these, 56 (40.3%) - acute respiratory distress syndrome (ARDS) with oxygen saturation on respiratory support of 88.9% (43-98). Inflammation was indicated by lymphopenia 0.98x10∗9/l (0.2-3.2), CRP 126 mg/l (1.4-421), ferritin 875 mg/l (7-3555). Signs of hypercoagulation were indicated by thrombocytopenia 166 x10∗9/l (5-468), D-dimer - 3092 ng/ml (126-19300), fibrinogen 5.4 g/l (1.4-12.1). Acute myocardial injury was present, with troponin I -2686 ng/l (2.2-50000). Installed thrombosis of the mesenteric, renal, hepatic vessels (5.4%), pulmonary embolism (5.3%), MI (5.3%), DAD with ARDS (67.9%), bleeding (1.8%), atrial fibrillation (35.6%), decompensation of heart defects (3.6%), infective endocarditis (1.8%). Conclusions: The incidence of strokes in patients with SARS-CoV-2 was 15.2% (out of 1000 people). Ischemic strokes are characteristic of COVID-19 brain damage. Polymorbidity of damage is an independent risk factor for deaths from strokes in elderly and senile patients with hypertension.