tetano
Editor, Senior Moderator
Ann Neurol
. 2020 Nov 21.
doi: 10.1002/ana.25967. Online ahead of print.
The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-analysis
Aristeidis H Katsanos[SUP] 1 2 [/SUP], Lina Palaiodimou[SUP] 2 [/SUP], Ramin Zand[SUP] 3 [/SUP], Shadi Yaghi[SUP] 4 [/SUP], Hooman Kamel[SUP] 5 [/SUP], Babak B Navi[SUP] 5 [/SUP], Guillaume Turc[SUP] 6 7 8 9 [/SUP], Michele Romoli[SUP] 10 11 [/SUP], Vijay K Sharma[SUP] 12 [/SUP], Dimitris Mavridis[SUP] 13 14 [/SUP], Shima Shahjouei[SUP] 3 [/SUP], Luciana Catanese[SUP] 1 [/SUP], Ashkan Shoamanesh[SUP] 1 [/SUP], Konstantinos Vadikolias[SUP] 15 [/SUP], Konstantinos Tsioufis[SUP] 16 [/SUP], Pagona Lagiou[SUP] 17 18 [/SUP], Andrei V Alexandrov[SUP] 19 [/SUP], Sotirios Tsiodras[SUP] 20 21 [/SUP], Georgios Tsivgoulis[SUP] 2 19 [/SUP]
Affiliations
Abstract
Objective: Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and highlights the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke. We conducteda systematic review and meta-analysis to evaluate the aforementioned considerations.
Methods: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARS-CoV-2 infection status. We used a random-effects model. Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI).
Results: We identified 18 cohort studies including 67,845 patients. Among patients with SARS-CoV-2, 1.3% (95%CI:0.9-1.6%;I[SUP]2[/SUP] =87%) were hospitalized for cerebrovascular events, 1.1% (95%CI:0.8-1.3%;I[SUP]2[/SUP] =85%) for ischemic stroke, and 0.2% (95%CI:0.1-0.3%; I[SUP]2[/SUP] =64%) for hemorrhagic stroke. Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR=3.58,95%CI:1.43-8.92; I[SUP]2[/SUP] =43%) and cryptogenic stroke (OR=3.98,95%CI:1.62-9.77;I[SUP]2[/SUP] =0%). Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical controls (OR=1.39, 95%CI:1.04-1.86; I[SUP]2[/SUP] =0%). SARS-CoV-2 infection status was not associated with the likelihood of receiving intravenous thrombolysis (OR=1.42,95%CI:0.65-3.10; I[SUP]2[/SUP] =0%) or endovascular thrombectomy (OR=0.78,95%CI:0.35-1.74; I[SUP]2[/SUP] =0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic. Odds for in-hospital mortality were higher among SARS-CoV-2stroke patients compared to non-infected contemporary or historical stroke patients (OR=5.60,95%CI:3.19-9.80;I[SUP]2[/SUP] =45%).
Interpretation: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke, and potentially cryptogenic stroke in particular. It may also be related to an increased mortality risk. This article is protected by copyright. All rights reserved.
Keywords: COVID-19;stroke; SARS-CoV-2; coronavirus; cryptogenic stroke; hemorrhagic stroke; ischemic stroke; meta-analysis; stroke care; systematic review.
. 2020 Nov 21.
doi: 10.1002/ana.25967. Online ahead of print.
The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-analysis
Aristeidis H Katsanos[SUP] 1 2 [/SUP], Lina Palaiodimou[SUP] 2 [/SUP], Ramin Zand[SUP] 3 [/SUP], Shadi Yaghi[SUP] 4 [/SUP], Hooman Kamel[SUP] 5 [/SUP], Babak B Navi[SUP] 5 [/SUP], Guillaume Turc[SUP] 6 7 8 9 [/SUP], Michele Romoli[SUP] 10 11 [/SUP], Vijay K Sharma[SUP] 12 [/SUP], Dimitris Mavridis[SUP] 13 14 [/SUP], Shima Shahjouei[SUP] 3 [/SUP], Luciana Catanese[SUP] 1 [/SUP], Ashkan Shoamanesh[SUP] 1 [/SUP], Konstantinos Vadikolias[SUP] 15 [/SUP], Konstantinos Tsioufis[SUP] 16 [/SUP], Pagona Lagiou[SUP] 17 18 [/SUP], Andrei V Alexandrov[SUP] 19 [/SUP], Sotirios Tsiodras[SUP] 20 21 [/SUP], Georgios Tsivgoulis[SUP] 2 19 [/SUP]
Affiliations
- PMID: 33219563
- DOI: 10.1002/ana.25967
Abstract
Objective: Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and highlights the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke. We conducteda systematic review and meta-analysis to evaluate the aforementioned considerations.
Methods: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARS-CoV-2 infection status. We used a random-effects model. Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI).
Results: We identified 18 cohort studies including 67,845 patients. Among patients with SARS-CoV-2, 1.3% (95%CI:0.9-1.6%;I[SUP]2[/SUP] =87%) were hospitalized for cerebrovascular events, 1.1% (95%CI:0.8-1.3%;I[SUP]2[/SUP] =85%) for ischemic stroke, and 0.2% (95%CI:0.1-0.3%; I[SUP]2[/SUP] =64%) for hemorrhagic stroke. Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR=3.58,95%CI:1.43-8.92; I[SUP]2[/SUP] =43%) and cryptogenic stroke (OR=3.98,95%CI:1.62-9.77;I[SUP]2[/SUP] =0%). Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical controls (OR=1.39, 95%CI:1.04-1.86; I[SUP]2[/SUP] =0%). SARS-CoV-2 infection status was not associated with the likelihood of receiving intravenous thrombolysis (OR=1.42,95%CI:0.65-3.10; I[SUP]2[/SUP] =0%) or endovascular thrombectomy (OR=0.78,95%CI:0.35-1.74; I[SUP]2[/SUP] =0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic. Odds for in-hospital mortality were higher among SARS-CoV-2stroke patients compared to non-infected contemporary or historical stroke patients (OR=5.60,95%CI:3.19-9.80;I[SUP]2[/SUP] =45%).
Interpretation: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke, and potentially cryptogenic stroke in particular. It may also be related to an increased mortality risk. This article is protected by copyright. All rights reserved.
Keywords: COVID-19;stroke; SARS-CoV-2; coronavirus; cryptogenic stroke; hemorrhagic stroke; ischemic stroke; meta-analysis; stroke care; systematic review.