Association between SARS-CoV-2 Seropositivity and Severity of Out-of-Hospital Acute Ischemic Stroke Following Asymptomatic/Mild COVID-19 in Children

Abstract

Objective This article investigates the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity and its association with the severity of new-onset acute ischemic stroke (AIS) among previously healthy children with asymptomatic/mild coronavirus disease 2019 (COVID-19).

Methods A case–control study that included children < 18 years with out-of-hospital AIS of undetermined etiology and a control group of healthy children. Exclusion criteria were current respiratory symptoms, previous COVID-19 diagnosis, prior COVID-19 vaccination, active SARS-CoV-2 infection, history of hospital admission in the last 6 months, and having a stroke predisposition. We screened children for SARS-CoV-2 immunoglobulin G antibodies using enzyme-linked immunosorbent assay. The severity of stroke was evaluated using the Pediatric National Institutes of Health Stroke Scale (PedNIHSS).

Results The current study included 25 children (15 males and 10 females; median age 24 months) with out-of-hospital AIS and 25 healthy controls (11 males and 14 females; median age 24 months). SARS-CoV-2 seropositivity was detected in 15 (60%) of AIS children and 11 (44%) among controls (p = 0.258). Compared with seronegative AIS children, those seropositive for SARS-CoV-2 had higher PedNIHSS scores (median 19 vs. 8.5; p = 0.001), pediatric intensive care unit admission (93.3% vs. 40%; p = 0.007), need for mechanical ventilation (53.3% vs. 10%; p = 0.040), and D-dimer levels (median 3.5 vs. 1.75 μg/mL; p < 0.001).

Conclusion SARS-CoV-2 seropositivity may be associated with more severe AIS affecting previously healthy children during the postacute phase of asymptomatic/mildly symptomatic COVID-19.