ABSTRACT
Resumen Introducción El COVID-19 puede desencadenar un infarto cerebral por varios mecanismos potenciales, entre ellas, la hipercoagulabilidad. Se han reportado peores resultados funcionales en pacientes con infarto cerebral y COVID-19. Objetivo Determinar la asociación entre resultado funcional y COVID-19 en pacientes con infarto cerebral isquémico. Pacientes y métodos Se realizó un estudio de casos y controles comparando a pacientes ingresados a un centro de referencia neurológico en Perú con diagnóstico de infarto cerebral, antes (controles) y después (casos) del inicio de la pandemia por COVID-19. Hubo 31 casos diagnosticados con COVID-19 y 62 controles. Se utilizaron análisis bivariado y análisis de regresión de Poisson de efectos fijos condicionales. Resultados Los casos tenían glucemia basal más alta (133,5, RIQ: 117,5-174 vs 117, RIQ: 101-130, p=0,033) que los controles, recuentos de neutrófilos más altos (7,91, RIQ: 5,93-9,57 vs. 5,96, RIQ: 4,41-7,79, p=0,008), menor recuento de linfocitos (1,48, RIQ: 1,04-1,8 frente a 1,83, RIQ: 1,26-2,32, p=0,025), mayor relación neutrófilos/linfocitos (5,44, RIQ: 4,0-8,1 frente a 3,29, RIQ: 2,25-6,02, p=0,011), mayor NIH scale/score (NIHSS) (14, RIQ: 9-18 vs. 7, RIQ: 5-11, p=0,000) y mayores puntuaciones de Rankin modificadas al alta (4, RIQ: 4-5 vs. 2, RIQ: 1-4) p=0,001). Siete (21,88%) participantes fallecieron en el grupo de casos vs. 1 (1,56%) en los controles (p=0,014). La odds ratio de un mal resultado funcional al alta fue de 1,344 (IC: 1,079-4,039;p=0,029), ajustada por NIHSS al ingreso. Conclusiones Nuestros hallazgos sugieren que los infartos cerebrales asociados a COVID-19 son más graves, tienen un peor resultado funcional y una mayor mortalidad que los infartos cerebrales no relacionados a COVID-19. Introduction COVID-19 seems to induce ischemic stroke by several potential mechanisms including promoting hypercoagulability, and worse functional outcomes have been reported in patients with stroke and the infection with SARS-CoV-2. Objective Determine the association between functional outcome and COVID-19 in patients with stroke. Patients and methods We performed a case control study comparing patients admitted to a neurological reference center in Peru with a diagnosis of stroke before (controls) and after (cases) the onset of the COVID-19 pandemic. There were 31 cases diagnosed with COVID-19 and 62 controls without COVID-19. Bivariate analysis and conditional fixed-effects Poisson regression analysis were used to evaluate the association between the functional outcome of the stroke and COVID-19. Results Cases had higher baseline serum glucose (133.5, IQR: 117.5-174 versus 117, IQR: 101-130, p=0.033) than controls, higher neutrophil counts (7.91, IQR: 5.93-9.57 versus 5.96, IQR: 4.41-7.79, p=0.008), lower lymphocyte counts (1.48, IQR: 1.04-1.8 versus 1.83, IQR: 1.26-2.32, p=0.025), higher neutrophil/lymphocyte ratios (5.44, IQR: 4.0-8.1 versus 3.29, IQR: 2.25-6.02, p=0.011), higher NIH stroke scale/score (NIHSS) (14, IQR: 9-18 versus 7 IQR: 5-11, p=0.000), and higher modified Rankin scores at discharge (4, IQR: 4-5 versus 2, IQR: 1-4), p=0.001). Seven (21.88%) participants died in the group of cases versus 1 (1.56%) in the controls (p=0.014). The odds ratio of having a bad functional outcome at discharge was 1.344 (CI: 1.079-4.039;p=0.029), adjusted by NIHSS at admission. Conclusions Our findings suggest that ischemic strokes associated with COVID-19 are more severe, have worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.