Acute Brain Ischemia, Infarction and Hemorrhage in Subjects Dying with or Without Autopsy-Proven Acute Pneumonia

  1. Thomas G. Beach
  2. Lucia I. Sue
  3. Anthony J. Intorcia
  4. Michael J. Glass
  5. Jessica E. Walker
  6. Richard Arce
  7. Courtney M. Nelson
  8. Geidy E. Serrano

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Abstract

Stroke is one of the most serious complications of Covid-19 disease but it is still unclear whether stroke is more common with Covid-19 pneumonia as compared to non-Covid-19 pneumonia. We investigated the concurrence rate of autopsy-confirmed acute brain ischemia, acute brain infarction and acute brain hemorrhage with autopsy-proven acute non-Covid pneumonia in consecutive autopsies in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND), a longitudinal clinicopathological study of normal aging and neurodegenerative diseases. Of 691 subjects with a mean age of 83.4 years, acute pneumonia was histopathologically diagnosed in 343 (49.6%); the concurrence rates for histopathologically-confirmed acute ischemia, acute infarction or subacute infarction was 14% and did not differ between pneumonia and non-pneumonia groups while the rates of acute brain hemorrhage were 1.4% and 2.0% of those with or without acute pneumonia, respectively. In comparison, in reviews of Covid-19 publications, reported clinically-determined rates of acute brain infarction range from 0.5% to 20% while rates of acute brain hemorrhage range from 0.13% to 2%. In reviews of Covid-19 autopsy studies, concurrence rates for both acute brain infarction and acute brain hemorrhage average about 10%. Covid-19 pneumonia and non-Covid-19 pneumonia may have similar risks tor concurrent acute brain infarction and acute brain hemorrhage when pneumonia is severe enough to cause death. Additionally, acute brain ischemia, infarction or hemorrhage may not be more common in subjects dying of acute pneumonia than in subjects dying without acute pneumonia.

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  1. ScreenIT

    SciScore for 10.1101/2021.03.22.21254139: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Program is approved by an Institutional Review Board and written informed consent is obtained from all subjects or their legal representatives.
    Consent: The Program is approved by an Institutional Review Board and written informed consent is obtained from all subjects or their legal representatives.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The AZSAND, through its Brain and Body Donation Program (https://www.brainandbodydonationregistration.org/) performs constitutively-rapid autopsies (median postmortem interval 3.0 hours for all 2,000 + autopsies) on Program participants and shares tissue samples with biomedical researchers worldwide 84.
    Body Donation Program
    suggested: (Brain and Body Donation Program, RRID:SCR_004822)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of our study is the lack of identification of the responsible pathogens. This is a common limitation to pneumonia studies 101. When pathogens are identified, they are viral more often than bacterial, with the top three in US hospitalized patients being human rhinovirus, influenza A and B, and Streptococcus pneumoniae 102. Although we did not attempt to determine, from clinical records or postmortem culture, the presence of associated pathogens, the confluent intra-alveolar accumulation of neutrophils is generally regarded as indicative of a bacterial cause 103 and therefore this study is likely to have been biased towards the inclusion of bacterial pneumonia and against the inclusion of purely viral pneumonia, although mixed bacterial and viral causes were very likely to have been common 101,102,103.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.03.22.21254139v1 on medRxiv