The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-Analysis

Aristeidis H. Katsanos, Lina Palaiodimou, Ramin Zand, Shadi Yaghi, Hooman Kamel, Babak B. Navi, Guillaume Turc, Michele Romoli, Vijay K. Sharma, Dimitris Mavridis, Shima Shahjouei, Luciana Catanese, Ashkan Shoamanesh, Konstantinos Vadikolias, Konstantinos Tsioufis, Pagona Lagiou, Andrei V. Alexandrov, Sotirios Tsiodras, Georgios Tsivgoulis

Research output: Contribution to journalArticlepeer-review

91 Scopus citations

Abstract

Objective: Emerging data indicate an increased risk of cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and highlight the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke. We conducted a 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 (CIs). Results: We identified 18 cohort studies including 67,845 patients. Among patients with SARS-CoV-2, 1.3% (95% CI = 0.9–1.6%, I2 = 87%) were hospitalized for cerebrovascular events, 1.1% (95% CI = 0.8–1.3%, I2 = 85%) for ischemic stroke, and 0.2% (95% CI = 0.1–0.3%, I2 = 64%) for hemorrhagic stroke. Compared to noninfected 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, I2 = 43%) and cryptogenic stroke (OR = 3.98, 95% CI = 1.62–9.77, I2 = 0%). Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to noninfected historical controls (OR = 1.39, 95% CI = 1.00–1.94, I2 = 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, I2 = 0%) or endovascular thrombectomy (OR = 0.78, 95% CI = 0.35–1.74, I2 = 0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic. Odds of in-hospital mortality were higher among SARS-CoV-2 stroke patients compared to noninfected contemporary or historical stroke patients (OR = 5.60, 95% CI = 3.19–9.80, I2 = 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. ANN NEUROL 2021;89:380–388.

Original languageEnglish (US)
Pages (from-to)380-388
Number of pages9
JournalAnnals of Neurology
Volume89
Issue number2
DOIs
StatePublished - Feb 2021

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-Analysis'. Together they form a unique fingerprint.

Cite this