PROGNASTIC SIGNIFICANCE OF VEGETATIVE CIRCULATION INDICATORS IN PATIENTS WHO HAVE SUFFERED ISCHEMIC STROKE WITH AND WITHOUT A NEW CORONAVIRUS INFECTION

A potential new method for predicting the course and outcome of ischemic stroke in the acute period developed against the background of COVID-19 is proposed based on qualitative and quantitative measurement of the autonomic regulation indices of the cardiovascular system, namely the autonomic circulation index. Today, stroke is the leading cause of disability in the population and the second leading cause of death worldwide. The increase in the number of strokes against the background of COVID-19 is explained by the fact that the SARS-CoV-2 coronavirus infection, due to its pathogenic effect, triggers a chain of morphological, metabolic and functional disorders, which, ultimately, are the trigger factors of ischemic stroke. The autonomic circulation index allows one to assess the state of the autonomic tone of the cardiovascular system quantitatively and dynamically, and compare it with the clinical condition of the patient. The aim of this work was to study the state of the autonomic circulation index in patients who had ischemic stroke against the background of the new coronavirus infection SARS-CoV-2 and without it. We examined 165 patients with ischemic stroke against the background of COVID-19, included in the main group, and 85 patients with ischemic stroke without confirmed COVID-19. On days 1, 7 and 14 after admission, all the patients had their autonomic circulation indices and the severity of ischemic stroke recorded according to the NIHSS scale. In addition, in all patients, concomitant and comorbid diseases were assessed using the Charlson Comorbidity Index and the Cumulative Illness Rating Scale. The study revealed that the concomitant comorbidity indices in patients in both groups did not differ statistically significantly. This indicates that in this sample of the patients, comorbidity had no prognostic significance in relation to the severity and outcome of ischemic stroke. However, it was found that pronounced sympathicotonia, developing on day 7, is precisely a prognostically unfavorable factor in the course and outcome of ischemic stroke both in the main group and in the comparison group, which is clinically proven by the NIHSS scores. In the main group, autonomic blood circulation parameters reached values of pronounced sympathicotonia, which is explained by the pathogenic effect of the SARS-CoV-2 virus on the microcirculatory bed, which leads to functional disorders of the midline structures of the brain responsible for the autonomic regulation of the body.

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