The Impact of SARS‐CoV‐2 on Stroke Epidemiology and Care: A Meta‐Analysis
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 met...
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| Published in | Annals of neurology Vol. 89; no. 2; pp. 380 - 388 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hoboken, USA
John Wiley & Sons, Inc
01.02.2021
Wiley Subscription Services, Inc Wiley |
| Subjects | |
| Online Access | Get full text |
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| 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 |
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| AbstractList | ObjectiveEmerging 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.MethodsWe 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).ResultsWe 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%).InterpretationSARS‐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 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.OBJECTIVEEmerging 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.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).METHODSWe 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).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%).RESULTSWe 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%).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.INTERPRETATIONSARS-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. 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 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. 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. 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). We identified 18 cohort studies including 67,845 patients. Among patients with SARS-CoV-2, 1.3% (95% CI = 0.9-1.6%, I = 87%) were hospitalized for cerebrovascular events, 1.1% (95% CI = 0.8-1.3%, I = 85%) for ischemic stroke, and 0.2% (95% CI = 0.1-0.3%, I = 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, I = 43%) and cryptogenic stroke (OR = 3.98, 95% CI = 1.62-9.77, I = 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, I = 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 = 0%) or endovascular thrombectomy (OR = 0.78, 95% CI = 0.35-1.74, I = 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, I = 45%). 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. |
| Author | Turc, Guillaume Zand, Ramin Alexandrov, Andrei V. Mavridis, Dimitris Catanese, Luciana Sharma, Vijay K. Palaiodimou, Lina Yaghi, Shadi Lagiou, Pagona Shoamanesh, Ashkan Kamel, Hooman Vadikolias, Konstantinos Tsiodras, Sotirios Shahjouei, Shima Navi, Babak B. Romoli, Michele Tsivgoulis, Georgios Katsanos, Aristeidis H. Tsioufis, Konstantinos |
| AuthorAffiliation | 7 University of Paris Paris France 10 Neurology Unit Maurizio Bufalini Hospital Cesena Italy 6 Department of Neurology Paris Psychiatry and Neurosciences University Hospital Group, Sainte Anne Hospital Paris France 2 Second Department of Neurology, Attikon Hospital, School of Medicine National and Kapodistrian University of Athens Athens Greece 8 INSERM U1266 Paris France 18 Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA 9 FHU Neurovasc Paris France 5 Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology Weill Cornell Medicine New York NY 20 Fourth Department of Internal Medicine, Attikon University Hospital National and Kapodistrian University of Athens Athens Greece 4 Department of Neurology NYU Langone Health New York NY 15 Department of Neurology, School of Medicine Democritus University of Thrace Alexandroupolis Greece 1 Division of Neurology McMaster University/Population Health Research Insti |
| AuthorAffiliation_xml | – name: 6 Department of Neurology Paris Psychiatry and Neurosciences University Hospital Group, Sainte Anne Hospital Paris France – name: 9 FHU Neurovasc Paris France – name: 2 Second Department of Neurology, Attikon Hospital, School of Medicine National and Kapodistrian University of Athens Athens Greece – name: 14 Faculty of Medicine Paris Descartes University Paris France – name: 13 Department of Primary Education University of Ioannina Ioannina Greece – name: 12 Division of Neurology, Department of Medicine, National University Hospital, Singapore and School of Medicine National University of Singapore Singapore – name: 20 Fourth Department of Internal Medicine, Attikon University Hospital National and Kapodistrian University of Athens Athens Greece – name: 4 Department of Neurology NYU Langone Health New York NY – name: 16 First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration Hospital Athens Greece – name: 18 Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA – name: 8 INSERM U1266 Paris France – name: 5 Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology Weill Cornell Medicine New York NY – name: 19 Department of Neurology University of Tennessee Health Science Center Memphis TN – name: 7 University of Paris Paris France – name: 10 Neurology Unit Maurizio Bufalini Hospital Cesena Italy – name: 21 National Public Health Organization of Greece Athens Greece – name: 1 Division of Neurology McMaster University/Population Health Research Institute Hamilton Ontario Canada – name: 15 Department of Neurology, School of Medicine Democritus University of Thrace Alexandroupolis Greece – name: 11 Neurology Clinic, University of Perugia–S. Maria del la Misericordia Hospital Perugia Italy – name: 17 Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine National and Kapodistrian University of Athens Athens Greece – name: 3 Neuroscience Institute, Geisinger Health System Danville PA |
| Author_xml | – sequence: 1 givenname: Aristeidis H. surname: Katsanos fullname: Katsanos, Aristeidis H. organization: National and Kapodistrian University of Athens – sequence: 2 givenname: Lina surname: Palaiodimou fullname: Palaiodimou, Lina organization: National and Kapodistrian University of Athens – sequence: 3 givenname: Ramin orcidid: 0000-0002-9477-0094 surname: Zand fullname: Zand, Ramin organization: Neuroscience Institute, Geisinger Health System – sequence: 4 givenname: Shadi orcidid: 0000-0003-0031-1004 surname: Yaghi fullname: Yaghi, Shadi organization: NYU Langone Health – sequence: 5 givenname: Hooman orcidid: 0000-0002-5745-0307 surname: Kamel fullname: Kamel, Hooman organization: Weill Cornell Medicine – sequence: 6 givenname: Babak B. orcidid: 0000-0001-8424-6128 surname: Navi fullname: Navi, Babak B. organization: Weill Cornell Medicine – sequence: 7 givenname: Guillaume surname: Turc fullname: Turc, Guillaume organization: FHU Neurovasc – sequence: 8 givenname: Michele surname: Romoli fullname: Romoli, Michele organization: Neurology Clinic, University of Perugia–S. Maria del la Misericordia Hospital – sequence: 9 givenname: Vijay K. surname: Sharma fullname: Sharma, Vijay K. organization: National University of Singapore – sequence: 10 givenname: Dimitris surname: Mavridis fullname: Mavridis, Dimitris organization: Paris Descartes University – sequence: 11 givenname: Shima surname: Shahjouei fullname: Shahjouei, Shima organization: Neuroscience Institute, Geisinger Health System – sequence: 12 givenname: Luciana surname: Catanese fullname: Catanese, Luciana organization: McMaster University/Population Health Research Institute – sequence: 13 givenname: Ashkan orcidid: 0000-0002-2802-1626 surname: Shoamanesh fullname: Shoamanesh, Ashkan organization: McMaster University/Population Health Research Institute – sequence: 14 givenname: Konstantinos surname: Vadikolias fullname: Vadikolias, Konstantinos organization: Democritus University of Thrace – sequence: 15 givenname: Konstantinos surname: Tsioufis fullname: Tsioufis, Konstantinos organization: National and Kapodistrian University of Athens, Hippokration Hospital – sequence: 16 givenname: Pagona surname: Lagiou fullname: Lagiou, Pagona organization: Harvard T. H. Chan School of Public Health – sequence: 17 givenname: Andrei V. surname: Alexandrov fullname: Alexandrov, Andrei V. organization: University of Tennessee Health Science Center – sequence: 18 givenname: Sotirios surname: Tsiodras fullname: Tsiodras, Sotirios organization: National Public Health Organization of Greece – sequence: 19 givenname: Georgios orcidid: 0000-0002-0640-3797 surname: Tsivgoulis fullname: Tsivgoulis, Georgios email: tsivgoulisgiorg@yahoo.gr organization: University of Tennessee Health Science Center |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33219563$$D View this record in MEDLINE/PubMed https://inserm.hal.science/inserm-03127042$$DView record in HAL |
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Emerging data indicate an increased risk of cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and highlight... Emerging data indicate an increased risk of cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and highlight the... ObjectiveEmerging data indicate an increased risk of cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and highlight the... Objective: Emerging data indicate an increased risk of cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and highlight... |
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| SubjectTerms | Cardiovascular system Case-Control Studies Comorbidity Confidence intervals Coronaviridae Coronaviruses COVID-19 COVID-19 - epidemiology Diabetes mellitus Diabetes Mellitus - epidemiology Epidemiology Health risks Hemorrhage Hospital Mortality Humans Infections Intravenous administration Ischemia Life Sciences Meta-analysis Mortality Mortality risk Neurons and Cognition Pandemics Respiratory diseases Risk SARS-CoV-2 Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Stroke Stroke - epidemiology Thrombectomy - statistics & numerical data Thrombolysis Thrombolytic drugs Thrombolytic Therapy - statistics & numerical data Viral diseases |
| Title | The Impact of SARS‐CoV‐2 on Stroke Epidemiology and Care: A Meta‐Analysis |
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