[Prediction of mortality in severe ischemic stroke during COVID-19 in patients with multiorgan dysfunction].

Abstract

Objective: To determine the prognostic value of multiorgan dysfunction (MOD) for the course and outcomes of severe ischemic stroke (IS) that occurred during the new coronavirus infection COVID-19.

Material and methods: A retrospective study included 110 patients with severe IS with 16 or more NIHSS points (National Institutes of Health Stroke Scale). The MOD severity on days 1 and 5 of hospitalization was assessed using the SAPS II score. The relationship between probable mortality and the severity of multiorgan dysfunction by SAPS-II in atherothrombotic and cardioembolic subtypes combined with COVID-19 was modeled. In order to determine the predictive significance of the model, a ROC analysis was performed.

Results: Non-survivors had higher SAPS II MOD severity on Day 1, with 33 (27; 39) points and 23 (20; 27) points, respectively (p=0.038). With the development of severe IS combined with COVID-19 complicated by MOD, an unfavorable outcome is significantly more often observed in the cardioembolic subtype compared with the atherothrombotic subtype (68.23% and 31.76%, respectively, p=0.045). The comparative regression analysis showed that the mortality probability was significantly higher in cardioembolic stroke for patients with MOD severity of 10 to 41 points on the SAPS II score (p=0.043). The results of the ROC analysis showed a high prognostic value of the SAPS II score for predicting death in severe IS that occurred during COVID-19 in patients with MOD. Also, in the cardioembolic subtype, the prognostic value of the SAPS II score is significantly higher than in the atherothrombotic subtype.

Conclusion: MOD is a key mortality-associated indicator in patients with severe IS and concomitant COVID-19. The mortality risk is significantly higher in patients with cardioembolic IS subtype.