Risk of a three-year ischemic stroke recurrence and its independent predictors in patients with a confirmed manifestationof viral infection

Abstract

Objective — to assess the risk of the manifest viral infection impact on the three‑year frequency of the recurrent stroke and to determine its independent predictors.Methods and subjects. From 2014 to 2019 70 patients with ischemic stroke with viral infection manifestation during 2 weeks before hospitalization were examined. The presence of viral infection was confirmed by a polymerase chain reaction (main group). A total of 220 patients without viral manifestation were included in the comparison group, who were compared with the main group by stroke severity, average age and gender. The severity of neurological deficiency was assessed by the NIHSS scale. The pathogenetic subtype of stroke was determined according to TOAST criteria.Results. Over the three‑year period, the three‑year cumulative rate of stroke recurrence was higher in main group patients — 17.4 % (non‑recurring survival 82.6 ± 4.58 %) than in comparison group — 12.1 % (non‑recurring survival 87.9 ± 2.2 %), p = 0.240. In the case of at least 2 types of viruses genomes presence in the blood, the frequency of recurrence has increased to 22.8 % (probability of non‑recurring survival 77.2 6.05 %), in comparison group — 12.1 % (probabilityofnon‑recurringsurvival 87.9 2 %), p = 0.0470. In the case of HSV1 determination, the risk of a stroke reccurence in the main group comparing to comparison group patients increased by 2.16 times: BP = 2.16; 95 % CI: 1.15 — 4.04 (p = 0.0154); HSV2 : 1.69: BP = 1.69; 95 % CI: 0.76 — 3.77 (p = 0.1983); HNV6 : 2.49: BP = 2.49; 95 % CI: 1.05 — 4.56 (p = 0.0356); CMV: 2.82: BP = 2.82; 95 % CI: 1.34 — 5.95 (p = 0.0065); EBV: 2.67 times: BP = 2.67; 95 % CI: 1.26 — 5.68 (p = 0.0106); Influenza virus: 2.64 times: BP = 2.64; 95 % CI: 1.17 — 5.95 (p = 0.0188). HSV1 (B coefficient = 4.52), CMV (B coefficient = 3.63), Influenza virus (B coefficient = 4.11), and Intima‑media thickness (B coefficient = 10.77), constant — 20.57 were determined as independent prognostic factors of a three‑year stroke recurrence in patients with viral manifestation. The predictive value of the model is high with an area of the figure under the ROC curve = 0.971, 95 % CI: 0.900 — 0.966 and model sensitivity — 100.0 %, 95 % CI: 71.5 — 100.0 % and specificity — 83.1 % (95 % CI: 71.0 — 91.6 %).Conclusions. The risk of a stroke recurrence with viral manifestation and the presence of herpes virus and influenza virus genome significantly increases in 1.89 times when two or more types of viruses are present and is 22.8 % to GP (12.1 %). The presence of HSV1, CMV DNA, influenza RNA, and Intima‑media thickness in the patient are the independent prognostic factors of a three‑year stroke recurrance in patients with viral manifestation according to the developed mathematical model using the step‑by‑step multivariant binary logistic regression.