Biological markers of inflammation and functional outcomes in patients who had coronavirus infection within 4 months prior to the development of ischemic stroke

Objective: to evaluate the functional outcomes of ischemic stroke (IS) depending on the level of biological markers of inflammation in blood serum in patients who had undergone coronavirus infection (CI) COVID-19.

Material and methods. The study included 80 patients with IS, 58 of whom had documented CI no later than 4 months prior to inclusion in the study. The comparison group consisted of 22 patients with IS who had not had any infectious diseases in the previous 4 months. The pathogenetic subtype of IS was determined according to the generally accepted SSS-TOAST classification. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcome was assessed using the modified Rankin Scale (mRS). In addition to routine laboratory tests, serum concentrations of a number of cytokines were determined in all patients using enzyme-linked immunosorbent assay. The list of measured parameters included interleukin 6 (IL6), monocyte chemoattractant protein 1 (MCP1), and interferon gamma (IFNγ). Only patients who did not receive thrombolytic therapy for various reasons were included in the study.

Results. In the main group, the proportion of patients with an unfavourable outcome (mRS ≥3) was 69%, while in the comparison group it was 23%. In all patients with IS who had COVID-19, a significant increase in the levels of leading mediators of the pro-inflammatory cytokine cascade, such as IL6 (p<0.05), MSP1 (p<0.05), acute phase proteins – CRP (p<0.05) and ferritin (p<0.05) was recorded in the peripheral bloodstream. These processes are observed against the background of a decrease in IFNγ content (p<0.05).

Conclusion. Patients with IS who have had COVID-19 have higher mRS scores at discharge, accompanied by elevated serum inflammatory markers. Given the results obtained, the most likely mechanisms for this effect may be systemic inflammation and endothelial dysfunction induced by COVID-19, as well as hypercoagulability syndrome, which contributes to a more severe course of stroke.

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