Clinical and laboratory features of the course of COVID-19-associated ischemic stroke with fatal outcome

Abstract

Objective. To study clinical and laboratory features of the course of terminal ischemic stroke (IS) associated with COVID-19. Material and methods. We analyzed 23 protocols of pathological examination of patients with IS who died in 2019 (group 1), and 24 protocols of patients with IS who died in 2020–2021. from complications caused by SARS-CoV-2 (group 2). Results. In group 2, a change in the pathogenetic structure of cerebral infarction was revealed, with a predominance of its unspecified variant. In addition, in group 2, males predominated. The average hospitalization time in group 2 was significantly longer compared to group 1. In addition to concomitant diseases (arterial hypertension, chronic heart failure), in group 2 there was a significant increase in both thrombosis of various vascular systems, pneumonia of varying localization and severity, as well as anemia. The general infectious syndrome in patients with IS is a criterion for an unfavorable prognosis, especially if the process of acute-phase inflammation is accompanied by suppression of red blood cells, which can be considered as a marker of an unfavorable course of IS. Conclusion. The combination of IS and COVID-19 forms a new pathogenetic subtype of cerebral infarction with deeper systemic manifestations. It can be assumed that this combination of clinical and laboratory changes is caused not only by massive hypoxia of internal organs, but also by the direct neuropathogenic effect of the virus.