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Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study

Yanan Li, Man Li, Mengdie Wang, Yifan Zhou, Jiang Chang, Ying Xian, David Wang, Ling Mao, Huijuan Jin, Bo Hu
DOI: 10.1136/svn-2020-000431 Published 19 July 2020
Yanan Li
1Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Man Li
1Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Mengdie Wang
1Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yifan Zhou
1Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Jiang Chang
2Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ying Xian
3Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
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David Wang
4Neurovascular Division, Department of Neurology, Barrow Neurological Institute/Saint Joseph Hospital Medical Center, Phoenix, Arizona, USA
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Ling Mao
1Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Huijuan Jin
1Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bo Hu
1Department of Neurology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Article Figures & Data

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    Figure 1

    Representative brain and chest images of patients COVID-19 with CVD. (A) Representative brain (A1) and chest (A2) CT images of patient 1 with new onset of ischaemic stroke. The red arrow showed location of infarct in figure A1. (B) Representative brain (B1) and chest (B2) CT images of patient 11 with new onset of intracerebral haemorrhage. CVD, cerebrovascular disease. The red arrow showed location of cerebral hemorrhage in figure B1.

Tables

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  • Table 1

    Baseline characteristics of patients with COVID-19 with new onset of CVD during infection

    Type of CVDSubtype of AISAge (years)SexSmoking
    history
    Drinking historyBlood pressure
    (mm Hg)
    Blood glucose (mmol/L)Type of patients with COVID-19 (severe/non-severe)Time between onset of SARS-CoV-2 infection and onset of CVD in daysNIHSS score of AIS onsetTreatment of CVDOutcome event
    1AISLarge-vessel atherosclerosis70sFNoNo110/676.0Severe233AntiplateletSurvival
    2AISSmall-vessel occlusion70sMNoNo110/705.4Severe293AntiplateletSurvival
    3AISLarge-vessel atherosclerosis50s MNoNo127/8313.2Non-severe14AntiplateletSurvival
    4AISCardioembolism80sMYesNo110/7213.8Severe198AntiplateletDeath
    5AISLarge-vessel atherosclerosis80s FNoNo140/8324.2Severe1520AntiplateletDeath
    6AISSmall-vessel occlusion70sMYesNo156/8211.0Severe12AntiplateletDeath
    7AISCardioembolism80sFNoNo97/646.8Non-severe123AnticoagulantDeath
    8AISLarge-vessel atherosclerosis90s FNoNo192/976.7Severe1028AnticoagulantSurvival
    9AISLarge-vessel atherosclerosis70sFNoNo155/897.9Severe1218AnticoagulantSurvival
    10AISCardioembolism70sMYesNo142/6716.3Severe835AnticoagulantDeath
    11ICH 60sMYesYes150/805.8Severe10 Death
    • *Patients with COVID-19 were confirmed by SARS-CoV-2 reverse transcription-PCR positive in throat swab and viral-like pneumonia in chest CT.

    • AIS, acute ischemic stroke; CVD, cerebrovascular disease; CVST, cerebral venous sinus thrombosis; F, female; ICH, intracerebral haemorrhage ; M, male; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TOAST, the Trial of Org 10 172 in Acute Stroke Treatment.

  • Table 2

    Clinical characteristics of patients with COVID-19 with or without new-onset CVD

    Total (N=219)COVID-19 with CVD (n=11)COVID-19 without CVD (n=208)P value*
    Age (years), mean±SD53.3±15.975.7±10.852.1±15.3
    Age (years), n (%)   <0.001
     <60132 (60.3)1 (9.1)131 (63.0)
     ≥6087 (39.7)10 (90.9)77 (37.0)
    Sex, n (%)   0.360
     Female130 (59.4)5 (45.5)125 (60.1)
    COVID-19   0.009
     Severe92 (42.0)9 (81.8)83 (39.9)
     Non-severe127 (58.0)2 (18.2)125 (60.1)
    Medical history, n (%)   
     Any85 (38.8)10 (90.9)75 (36.1)<0.001
     Hypertension55 (25.1)9 (81.8)46 (22.1)<0.001
     Diabetes31 (14.2)6 (54.5)25 (12.0)0.001
     Heart disease and CVD17 (7.8)3 (27.3)14 (6.7)0.044
     Malignancy14 (6.4)1 (9.1)13 (6.3)0.525
    • Data are presented as mean±SD and n/N (%).

    • P values indicate differences between patients with COVID-19 with and without new-onset CVD. P<0.05 was considered statistically significant.

    • *Fisher exact test.

    • CVD, cerebrovascular disease.

  • Table 3

    Laboratory findings of patients with COVID-19 with or without new-onset CVD

    Total
    (N=219)
    COVID-19 with CVD (n=11)COVID-19 without CVD (n=208)P value*
    White blood cell count, ×109/L5.0 (0.1–20.4)7.7 (3.9–14.8)4.9 (0.1–20.4)0.002
    Neutrophil, ×109/L3.1 (0.0–18.7)6.4 (0.0–13.8)3.0 (0.0–18.7)0.003
    Lymphocyte count, ×109/L1.1 (0.1–2.6)0.6 (0.3–1.2)1.1 (0.1–2.6)<0.001
    Platelet count, ×109/L206.0 (18.0–583.0)142.0 (90.0–564.0)211.0 (18.0–583.0)0.035
    C reactive protein (mg/L)12.5 (0.1–212.0)51.1 (1.3–127.9)12.1 (0.1–212.0)0.025
    D-dimer (mg/L)0.5 (0.1–20.0)6.9 (0.3–20.0)0.5 (0.1–20.0)<0.001
    Alanine aminotransferase (U/L)26.0 (5.0–1933.0)24.0 (13.0–144.0)26.5 (5.0–1933.0)0.671
    Aspartate aminotransferase (U/L)26.0 (8.0–8191.0)32.0 (19.0–271.0)26.0 (8.0–8191·0)0.119
    Blood urea nitrogen (mmol/L)4.1 (1.5–48.1)7.4 (4.0–43.2)4.1 (1.5–48.1)<0.001
    Creatinine (μmol/L)68.3 (35.9–9435.0)75.5 (42.7–261.3)68.2 (35.9–9435.0)0.02
    • P values indicate differences between patients with COVID-19 with and without new-onset CVD. P<0.05 was considered statistically significant.

    • *Wilcox non-parameter test.

    • CVD, cerebrovascular disease.

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Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study
Yanan Li, Man Li, Mengdie Wang, Yifan Zhou, Jiang Chang, Ying Xian, David Wang, Ling Mao, Huijuan Jin, Bo Hu
Stroke and Vascular Neurology Jul 2020, svn-2020-000431; DOI: 10.1136/svn-2020-000431

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Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study
Yanan Li, Man Li, Mengdie Wang, Yifan Zhou, Jiang Chang, Ying Xian, David Wang, Ling Mao, Huijuan Jin, Bo Hu
Stroke and Vascular Neurology Jul 2020, svn-2020-000431; DOI: 10.1136/svn-2020-000431
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Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study
Yanan Li, Man Li, Mengdie Wang, Yifan Zhou, Jiang Chang, Ying Xian, David Wang, Ling Mao, Huijuan Jin, Bo Hu
Stroke and Vascular Neurology Jul 2020, svn-2020-000431; DOI: 10.1136/svn-2020-000431
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