Mathematical modeling of outcomes in patients with clinical combination of ischemic stroke and COVID-19 complicated by multiple organ failure

Multiple organ failure in patients with severe ischemic stroke is a predictor of unfavorable clinical course and prognosis. In turn, COVID-19 increases the risk of ischemic stroke. Identification of prognostic patterns of multiple organ failure in patients with severe ischemic stroke and COVID-19 may be important for decision support in the management of these patients. Objective. To determine predictive value of multiple organ failure regarding the course and outcomes of severe ischemic stroke following COVID-19. Material and methods. A retrospective study included 110 COVID-19 patients with severe ischemic stroke NIHSS score ≥16. Severity of multiple organ failure in 1 and 5 days after admission was assessed using standard SAPS II and SOFA scales. Regression analysis using the least squares method was performed to determine significance of indicators. Results. Dead patients were characterized by more severe multiple organ failure according to SAPS II scale on day 1 (33 (27—39) and 23 (20—27) points, respectively, p=0.038). In case of severe ischemic stroke and COVID-19 complicated by multiple organ failure, unfavorable outcomes were significantly more common in cardioembolic subtype compared to atherothrombotic subtype (87% and 63%, respectively, p=0.004). According to regression analysis, probable mortality was significantly higher in cardioembolic stroke for patients with SAPS II score 30—41 (p=0.043). Serum C-reactive protein was significantly higher in dead patients compared to survivors (p=0.024). Conclusion. Early multiple organ failure is the most important predictor of death in clinical combination of COVID-19 and severe ischemic stroke. Mortality was significantly higher in patients with cardioembolic subtype, severe acute respiratory failure and increased serum markers of systemic inflammation.