tetano
Editor, Senior Moderator
Stroke
. 2021 Aug 25;STROKEAHA121035045.
doi: 10.1161/STROKEAHA.121.035045. Online ahead of print.
Biomarkers of Coagulation and Inflammation in COVID-19-Associated Ischemic Stroke
Charles Esenwa[SUP] 1 [/SUP], Natalie T Cheng[SUP] 1 [/SUP], Jorge Luna[SUP] 2 [/SUP], Joshua Willey[SUP] 2 [/SUP], Amelia K Boehme[SUP] 2 [/SUP], Kathryn Kirchoff-Torres[SUP] 1 [/SUP], Daniel Labovitz[SUP] 1 [/SUP], Ava L Liberman[SUP] 1 [/SUP], Peter Mabie[SUP] 1 [/SUP], Khadean Moncrieffe[SUP] 1 [/SUP], Ainie Soetanto[SUP] 1 [/SUP], Andrea Lendaris[SUP] 1 [/SUP], Johanna Seiden[SUP] 1 [/SUP], Inessa Goldman[SUP] 3 [/SUP], David Altschul[SUP] 4 [/SUP], Ryan Holland[SUP] 4 [/SUP], Joshua Benton[SUP] 5 [/SUP], Joseph Dardick[SUP] 5 [/SUP], Jenelys Fernandez-Torres[SUP] 5 [/SUP], David Flomenbaum[SUP] 5 [/SUP], Jenny Lu[SUP] 5 [/SUP], Avinash Malaviya, Nikunj Patel[SUP] 5 [/SUP], Aureliana Toma[SUP] 5 [/SUP], Aaron Lord[SUP] 6 [/SUP], Koto Ishida[SUP] 6 [/SUP], Jose Torres[SUP] 6 [/SUP], Thomas Snyder[SUP] 6 [/SUP], Jennifer Frontera[SUP] 6 [/SUP], Shadi Yaghi[SUP] 6 [/SUP]
Affiliations
Abstract
Background and purpose: We sought to determine if biomarkers of inflammation and coagulation can help define coronavirus disease 2019 (COVID-19)-associated ischemic stroke as a novel acute ischemic stroke (AIS) subtype.
Methods: We performed a machine learning cluster analysis of common biomarkers in patients admitted with severe acute respiratory syndrome coronavirus 2 to determine if any were associated with AIS. Findings were validated using aggregate data from 3 large healthcare systems.
Results: Clustering grouped 2908 unique patient encounters into 4 unique biomarker phenotypes based on levels of c-reactive protein, D-dimer, lactate dehydrogenase, white blood cell count, and partial thromboplastin time. The most severe cluster phenotype had the highest prevalence of AIS (3.6%, P<0.001), in-hospital AIS (53%, P<0.002), severe AIS (31%, P=0.004), and cryptogenic AIS (73%, P<0.001). D-dimer was the only biomarker independently associated with prevalent AIS with quartile 4 having an 8-fold higher risk of AIS compared to quartile 1 (P=0.005), a finding that was further corroborated in a separate cohort of 157 patients hospitalized with COVID-19 and AIS.
Conclusions: COVID-19-associated ischemic stroke may be related to COVID-19 illness severity and associated coagulopathy as defined by increasing D-dimer burden.
Keywords: COVID-19; biomarker; inflammation; ischemic stroke; mortality.
. 2021 Aug 25;STROKEAHA121035045.
doi: 10.1161/STROKEAHA.121.035045. Online ahead of print.
Biomarkers of Coagulation and Inflammation in COVID-19-Associated Ischemic Stroke
Charles Esenwa[SUP] 1 [/SUP], Natalie T Cheng[SUP] 1 [/SUP], Jorge Luna[SUP] 2 [/SUP], Joshua Willey[SUP] 2 [/SUP], Amelia K Boehme[SUP] 2 [/SUP], Kathryn Kirchoff-Torres[SUP] 1 [/SUP], Daniel Labovitz[SUP] 1 [/SUP], Ava L Liberman[SUP] 1 [/SUP], Peter Mabie[SUP] 1 [/SUP], Khadean Moncrieffe[SUP] 1 [/SUP], Ainie Soetanto[SUP] 1 [/SUP], Andrea Lendaris[SUP] 1 [/SUP], Johanna Seiden[SUP] 1 [/SUP], Inessa Goldman[SUP] 3 [/SUP], David Altschul[SUP] 4 [/SUP], Ryan Holland[SUP] 4 [/SUP], Joshua Benton[SUP] 5 [/SUP], Joseph Dardick[SUP] 5 [/SUP], Jenelys Fernandez-Torres[SUP] 5 [/SUP], David Flomenbaum[SUP] 5 [/SUP], Jenny Lu[SUP] 5 [/SUP], Avinash Malaviya, Nikunj Patel[SUP] 5 [/SUP], Aureliana Toma[SUP] 5 [/SUP], Aaron Lord[SUP] 6 [/SUP], Koto Ishida[SUP] 6 [/SUP], Jose Torres[SUP] 6 [/SUP], Thomas Snyder[SUP] 6 [/SUP], Jennifer Frontera[SUP] 6 [/SUP], Shadi Yaghi[SUP] 6 [/SUP]
Affiliations
- PMID: 34428931
- DOI: 10.1161/STROKEAHA.121.035045
Abstract
Background and purpose: We sought to determine if biomarkers of inflammation and coagulation can help define coronavirus disease 2019 (COVID-19)-associated ischemic stroke as a novel acute ischemic stroke (AIS) subtype.
Methods: We performed a machine learning cluster analysis of common biomarkers in patients admitted with severe acute respiratory syndrome coronavirus 2 to determine if any were associated with AIS. Findings were validated using aggregate data from 3 large healthcare systems.
Results: Clustering grouped 2908 unique patient encounters into 4 unique biomarker phenotypes based on levels of c-reactive protein, D-dimer, lactate dehydrogenase, white blood cell count, and partial thromboplastin time. The most severe cluster phenotype had the highest prevalence of AIS (3.6%, P<0.001), in-hospital AIS (53%, P<0.002), severe AIS (31%, P=0.004), and cryptogenic AIS (73%, P<0.001). D-dimer was the only biomarker independently associated with prevalent AIS with quartile 4 having an 8-fold higher risk of AIS compared to quartile 1 (P=0.005), a finding that was further corroborated in a separate cohort of 157 patients hospitalized with COVID-19 and AIS.
Conclusions: COVID-19-associated ischemic stroke may be related to COVID-19 illness severity and associated coagulopathy as defined by increasing D-dimer burden.
Keywords: COVID-19; biomarker; inflammation; ischemic stroke; mortality.