PO136 | PHENOTYPE CHARACTERIZATION OF PATIENTS HOSPITALIZED FOR ACUTE SARS-COV2 INFECTION WITH AND WITHOUT ACUTE CEREBRAL ISCHEMIA

P. Agosti^1|2, R. Gualtierotti^1|2, C. Suffritti¹, L. Valenti^2|3, M. Morena², M. Tettamanti⁴, A. Nobili⁴, A. Bandera^2|5, F. Peyvandi^1|2 | ¹Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milano, Italy; ²Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milano, Italy; ³Department of Transfusion Medicine and Biological Resource Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; ⁴Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy; ⁵Department of Infectious Diseases, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy

Background and Aims. Severe acute SARS-CoV2 infection is a well known model of systemic inflammatory response syndrome (SIRS), characterized by a strong activation of both inflammatory and coagulation pathways leading to multiorgan vascular and microvascular damage. To date, evidence on cerebrovascular complications occurring during acute SARS-CoV2 infection is still scarce. This study aims to estimate the prevalence of acute cerebral ischemia in a large cohort of patients hospitalized for acute SARS-CoV2 infection and to identify the main patient- and disease-related risk factors.
Methods. All patients included in the frame of the COVID-19 Network with available information on the primary endpoint (cerebral ischemia yes/no) were enrolled. The Registry, started from March 2020, included all consecutive adults (aged ≥18 years) with a positive RT-PCR result for SARS-CoV-2 at the time of hospital admission. All the Register-related details are reported elsewhere (doi: 10.1016/j.cmi.2020.06.028).
Results. Among 1412 patients hospitalized for acute Sars-CoV2 infection, we observed 19 cases with acute cerebral ischemia, including 11 imaging-proven ischemic stroke (IS) and 8 transient ischemic attack (TIA). Patients with acute cerebral ischemia (TIA or IS) were older compared with patients without, with a higher proportion of hypertension, ischemic heart disease/heart failure and history of IS/TIA. As regards laboratory parameters, we observed higher troponin levels and lower platelet and lymphocyte counts in patients with acute cerebral ischemia. Routine hemostatic and inflammatory laboratory parameters were comparable and within normal range in both groups. In-hospital mortality was significantly higher in patients with acute cerebral ischemia during acute SARS-CoV2 infection (Table). Consistently, reservoir mask was used more in these patients (18.8% vs 3.5 %, p=0.001).
Conclusions. In a large cohort of patients hospitalized for acute Sars-CoV2 infection (n=1412), we found an incidence proportion of 1.3% of acute cerebral ischemia, 0.8% of IS. Specific patient-related features (age, hypertension, history of IS/TIA, ischemic heart disease/heart failure) seemed to influence the risk of acute cerebral ischemia during acute SARS-CoV-2 infection. In these patients, the early detection of IS/TIA is very important considering its impact on in-hospital mortality risk. Monitoring specific laboratory parameters of disease severity (platelet count, lymphocytes and tropinin level) could be useful.