Do Elevated Levels of Inflammatory Biomarkers Predict the Risk of Occurrence of Ischemic Stroke in SARS-CoV2 ?: An Observational Study.

INTRODUCTION: Stroke, a dreaded complication of SARS-CoV2, has been reported in 0.9 to 5% of SARS-CoV2 patients. There are concerns that SARS-CoV2 infection has a significant independent association with acute ischemic stroke, even in the absence of conventional cerebrovascular risk factors. Whether elevated levels of inflammatory biomarkers have predictive value in the occurrence of stroke in SARS-CoV2 is poorly understood. AIM: To profile the characteristics of SARS-CoV2 positive patients with ischemic stroke (COVID-Stroke) and to identify the significance of elevated IBMs in the prediction of ischemic COVID-stroke. MATERIALS AND METHODS: Clinical characteristics, stroke risk factors, laboratory parameters- including levels of inflammatory biomarkers, and outcome of SARS-CoV2 patients with stroke (n=60) were collected. SARS-CoV2 RT- PCR positive age, gender, and pulmonary severity matched non-stroke patients were taken as controls (n = 60). Binary multivariate logistic regression analysis was used to find the predictors of ischemic COVID-stroke. RESULTS: D-dimer > 441.8 ng/mL, LDH> 395U/L, ESR >19 mm/h and CRP> 0.2 mg/dL were independently found to be very strong predictors of occurrence of ischemic COVID-stroke (p < 0.001 for each). On multivariate analysis, D-dimer > 441.8 ng/mL, ESR > 19 mm/h, and RDW > 16.1% were found to be the most strong predictors of the occurrence of ischemic COVID-stroke. Conventional CVD risk factors- higher age (> 60years), presence of diabetes mellitus, and hypertension were not found to be significant predictors in multivariate analysis. CONCLUSION: In SARS-CoV2 patients, D-dimer elevated beyond 441.8 ng/mL, ESR greater than 19 mm/h, and RDW widened more than 16.1% were the strongest predictors of the occurrence of ischemic stroke. This is the first study that attempts to find cut-off levels of IBMs in the prediction of ischemic COVID-stroke.

Neurological Symptoms as Initial Manifestation of Covid-19 - An Observational Study.

BACKGROUND: Respiratory system involvement and fever are considered as a cardinal manifestation of Covid-19 infection for the screening of case detection. We (India) are into the fourth month of Covid-19 and cases are still rising, this could mean that fever and respiratory symptoms may not be the only initial symptoms. Therefore, we intend to investigate whether neurological symptoms can precede the cardinal symptoms. METHODS: Totally, 391 Covid-19 RTPCR positive hospitalized patients were enrolled. All included subjects were presented with a questionnaire pertaining to systemic symptoms. For analysis of the chronology of symptoms, the study population was sub-grouped according to onset of their systemic involvement e.g., (1) Fever (2) Respiratory symptoms (3) Neurological symptoms (4) Gastrointestinal symptoms. RESULTS: New-onset neurological symptoms were found in 106 (27.1%) out of 391 patients irrespective of their chronology to the onset of other symptoms. Of these 106 patients, altered taste (33.1%), altered smell (24.5%), and headache (22.6%) were the most common neurological symptoms. However, 38 (9.7%) subjects recognized neurological symptoms, as the initial manifestation of their illness. Mean duration of neurological symptoms before the onset of respiratory symptoms or fever was 2 ± 1.57 days. CONCLUSION: New-onset headache, altered taste, and smell were the most common neurological symptoms. In the context of the current pandemic, a high index of suspicion should be kept in patients presenting with these symptoms even in the absence of fever and respiratory symptoms. To the best of our knowledge, this is the first study from India comparing chronology of neurological symptoms with cardinal symptoms.