Acute cerebrovascular events in severe and nonsevere COVID-19 patients: a systematic review and meta-analysis

• Published in: Reviews in the neurosciences Vol. 33; no. 6; pp. 631 - 639
• Main Authors: Quintanilla-Sánchez, Carolina, Salcido-Montenegro, Alejandro, González-González, José Gerardo, Rodríguez-Gutiérrez, René
• Format: Journal Article
• Language: English
• Published: Germany De Gruyter 26.08.2022; Walter de Gruyter GmbH
• Subjects: Case reports; Coronaviruses; COVID-19; Hemorrhage; hemorrhagic stroke; Ischemia; ischemic stroke; Meta-analysis; Mortality; sinus venous thrombosis; Stroke; Systematic review; transitory ischemic attack; COVID-19; hemorrhagic stroke; sinus venous thrombosis; stroke; transitory ischemic attack; ischemic stroke
• ISSN: 0334-1763; 2191-0200
• DOI: 10.1515/revneuro-2021-0130

The degree to which COVID-19 severity influences the development of acute cerebrovascular events (ACVE) is unknown. Therefore, we aimed to describe the prevalence and risk of ACVE in patients with severe and nonsevere COVID-19. We systematically reviewed MEDLINE, EMBASE, Web of Science, and Scopus and identified observational and interventional studies of patients with COVID-19 allocated by respiratory severity that reported ACVE development. Case reports/series were excluded. The main outcome assessed was the pooled rate of ACVE in patients with severe and nonsevere COVID-19. To determine the risk of ACVE development by COVID-19 severity, a meta-analysis was performed. PROSPERO registration number: . About 19 of 5758 identified studies were analyzed. From 11,886 COVID-19 patients analyzed, 421 had at least one ACVE [3.6%, 95% confidence interval (CI) 2.904–4.179]. Severe COVID-19 increased the risk of ACVE (odds ratio 1.96, 95% CI 1.22–3.15; 0.005;  = 64%), specifically hemorrhagic stroke (4.12, 2.0–8.53; 0.001;  = 0%). There was no difference in the risk of developing ischemic stroke between patients with severe and nonsevere COVID-19 (1.53, 0.87–2.7; 0.14;  = 52%). From the patients who developed any ACVE, those with severe COVID-19 had a greater mortality risk than those with nonsevere COVID-19 (3.85, 1.08–13.70; 0.04;  = 0%). The main limitations of our study were the heterogeneity found in the main meta-analysis studies and in their reported definition for COVID-19 severity. In conclusion, our findings provide evidence that COVID-19 respiratory severity could lead to ACVE development that increases mortality. The effect of COVID-19 management in ACVE needs to be evaluated.