Acute cerebrovascular events in severe and nonsevere COVID-19 patients: a systematic review and meta-analysis
Author:
Quintanilla-Sánchez Carolina12ORCID, Salcido-Montenegro Alejandro3ORCID, González-González José Gerardo3ORCID, Rodríguez-Gutiérrez René3ORCID
Affiliation:
1. IMPRS Neuroscience, George August Göttingen University , Göttingen 37077 , Germany 2. Plataforma INVEST UANL-KER Unit Mayo Clinic, School of Medicine and University Hospital “Dr. José E González”, Universidad Autónoma de Nuevo León , Monterrey 64460 , México 3. Department of Internal Medicine and Plataforma INVEST UANL-KER Unit Mayo Clinic , School of Medicine and “Dr. José E. González” University Hospital, Universidad Autónoma de Nuevo León , Monterrey 64460 , N.L . México
Abstract
Abstract
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: CRD42020178905. 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; P = 0.005; I
2 = 64%), specifically hemorrhagic stroke (4.12, 2.0–8.53; P = 0.001; I
2 = 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; P = 0.14; I
2 = 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; P = 0.04; I
2 = 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.
Publisher
Walter de Gruyter GmbH
Subject
General Neuroscience
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