Increased risk of acute stroke among patients with severe COVID-19: a multicenter study and meta-analysis
Research output: Contribution to journal › Research article › Contributed › peer-review
Contributors
Abstract
BACKGROUND AND PURPOSE: Recent observations linked coronavirus disease 2019 (COVID-19) to thromboembolic complications possibly mediated by increased blood coagulability and inflammatory endothelial impairment. We aimed to define the risk of acute stroke in patients with severe and non-severe COVID-19.
METHODS: We performed an observational, multicenter cohort study in four participating hospitals in Saxony, Germany to characterize consecutive patients with laboratory-confirmed COVID-19 who experienced acute stroke during hospitalization. Furthermore, we conducted a systematic review using PubMed/MEDLINE, Embase, Cochrane Library and bibliographies of identified papers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines including data from observational studies of acute stroke in COVID-19 patients. Data were extracted by two independent reviewers and pooled with multicenter data to calculate risk ratios (RRs) and 95% confidence intervals (95% CIs) for acute stroke related to COVID-19 severity using a random-effects model. Between-study heterogeneity was assessed using Cochran's Q and I2 statistics. International Prospective Register of Systematic Reviews registration number: CRD42020187194.
RESULTS: Of 165 patients hospitalized for COVID-19 (49.1% males, median age = 67 years [57-79 years], 72.1% severe or critical) included in the multicenter study, overall stroke rate was 4.2% (95% CI: 1.9-8.7). Systematic literature search identified two observational studies involving 576 patients that were eligible for meta-analysis. Amongst 741 pooled COVID-19 patients, overall stroke rate was 2.9% (95% CI: 1.9-4.5). Risk of acute stroke was increased for patients with severe compared to non-severe COVID-19 (RR = 4.18, 95% CI: 1.7-10.25; P = 0.002) with no evidence of heterogeneity (I2 = 0%, P = 0.82).
CONCLUSIONS: Synthesized analysis of data from our multicenter study and previously published cohorts indicates that severity of COVID-19 is associated with an increased risk of acute stroke.
Details
Original language | English |
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Pages (from-to) | 238-247 |
Number of pages | 10 |
Journal | European journal of neurology |
Volume | 28 |
Issue number | 1 |
Publication status | Published - Jan 2021 |
Peer-reviewed | Yes |
External IDs
Scopus | 85092103084 |
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ORCID | /0000-0003-3953-3253/work/142251749 |
ORCID | /0000-0001-9473-3018/work/148606185 |
Keywords
Keywords
- Aged, Aged, 80 and over, COVID-19/complications, Cohort Studies, Female, Germany/epidemiology, Hospitalization/statistics & numerical data, Humans, Male, Middle Aged, Risk Factors, Stroke/complications, Thromboembolism/epidemiology