Stroke in COVID-19: A systematic review and meta-analysis.

Tytuł:: Stroke in COVID-19: A systematic review and meta-analysis.
Autorzy:: Nannoni S; Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK.
de Groot R; Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands.
Bell S; Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK.
Markus HS; Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK.
Źródło:: International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2021 Feb; Vol. 16 (2), pp. 137-149. Date of Electronic Publication: 2020 Nov 11.
Typ publikacji:: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Systematic Review
Język:: English
Imprint Name(s):: Publication: 2016- : Thousand Oaks, CA : SAGE Publications
Original Publication: Oxford, UK : Blackwell Pub., c2005-
MeSH Terms:: Brain Ischemia/*diagnostic imaging
Brain Ischemia/*epidemiology
COVID-19/*diagnostic imaging
COVID-19/*epidemiology
Stroke/*diagnostic imaging
Stroke/*epidemiology
Brain Ischemia/metabolism ; COVID-19/metabolism ; Humans ; Observational Studies as Topic/methods ; Risk Factors ; Stroke/metabolism
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Grant Information:: MR/N026896/1 United Kingdom MRC_ Medical Research Council; RG/16/4/32218 United Kingdom BHF_ British Heart Foundation
Contributed Indexing:: Keywords: COVID-19; SARS-CoV-2; Stroke; acute cerebrovascular disease; hemorrhagic stroke
Entry Date(s):: Date Created: 20201026 Date Completed: 20210209 Latest Revision: 20210217
Update Code:: 20240105
PubMed Central ID:: PMC7859578
DOI:: 10.1177/1747493020972922
PMID:: 33103610
: Czasopismo naukowe

Background: Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases is unclear.
Aims: We aimed to characterize the incidence, risk factors, clinical-radiological manifestations, and outcome of COVID-19-associated stroke.
Methods: Three medical databases were systematically reviewed for published articles on acute cerebrovascular diseases in COVID-19 (December 2019-September 2020). The review protocol was previously registered (PROSPERO ID = CRD42020185476). Data were extracted from articles reporting ≥5 stroke cases in COVID-19. We complied with the PRISMA guidelines and used the Newcastle-Ottawa Scale to assess data quality. Data were pooled using a random-effect model.
Summary of Review: Of 2277 initially identified articles, 61 (2.7%) were entered in the meta-analysis. Out of 108,571 patients with COVID-19, acute CVD occurred in 1.4% (95%CI: 1.0-1.9). The most common manifestation was acute ischemic stroke (87.4%); intracerebral hemorrhage was less common (11.6%). Patients with COVID-19 developing acute cerebrovascular diseases, compared to those who did not, were older (pooled median difference = 4.8 years; 95%CI: 1.7-22.4), more likely to have hypertension (OR = 7.35; 95%CI: 1.94-27.87), diabetes mellitus (OR = 5.56; 95%CI: 3.34-9.24), coronary artery disease (OR = 3.12; 95%CI: 1.61-6.02), and severe infection (OR = 5.10; 95%CI: 2.72-9.54). Compared to individuals who experienced a stroke without the infection, patients with COVID-19 and stroke were younger (pooled median difference = -6.0 years; 95%CI: -12.3 to -1.4), had higher NIHSS (pooled median difference = 5; 95%CI: 3-9), higher frequency of large vessel occlusion (OR = 2.73; 95%CI: 1.63-4.57), and higher in-hospital mortality rate (OR = 5.21; 95%CI: 3.43-7.90).
Conclusions: Acute cerebrovascular diseases are not uncommon in patients with COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors. The pattern of large vessel occlusion and multi-territory infarcts suggests that cerebral thrombosis and/or thromboembolism could be possible causative pathways for the disease.

Comment in: Int J Stroke. 2021 Feb;16(2):121-122. (PMID: 33527890)

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