新冠病毒感染相关脑卒中：一项系统评价和荟萃分析。

Stroke in COVID-19: A systematic review and meta-analysis.

机构信息

Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK.

Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands.

出版信息

Int J Stroke. 2021 Feb;16(2):137-149. doi: 10.1177/1747493020972922. Epub 2020 Nov 11.

DOI:10.1177/1747493020972922

PMID:33103610

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7859578/

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases is unclear.

AIMS

We aimed to characterize the incidence, risk factors, clinical-radiological manifestations, and outcome of COVID-19-associated stroke.

METHODS

Three medical databases were systematically reviewed for published articles on acute cerebrovascular diseases in COVID-19 (December 2019-September 2020). The review protocol was previously registered (PROSPERO ID = CRD42020185476). Data were extracted from articles reporting ≥5 stroke cases in COVID-19. We complied with the PRISMA guidelines and used the Newcastle-Ottawa Scale to assess data quality. Data were pooled using a random-effect model.

SUMMARY OF REVIEW

Of 2277 initially identified articles, 61 (2.7%) were entered in the meta-analysis. Out of 108,571 patients with COVID-19, acute CVD occurred in 1.4% (95%CI: 1.0-1.9). The most common manifestation was acute ischemic stroke (87.4%); intracerebral hemorrhage was less common (11.6%). Patients with COVID-19 developing acute cerebrovascular diseases, compared to those who did not, were older (pooled median difference = 4.8 years; 95%CI: 1.7-22.4), more likely to have hypertension (OR = 7.35; 95%CI: 1.94-27.87), diabetes mellitus (OR = 5.56; 95%CI: 3.34-9.24), coronary artery disease (OR = 3.12; 95%CI: 1.61-6.02), and severe infection (OR = 5.10; 95%CI: 2.72-9.54). Compared to individuals who experienced a stroke without the infection, patients with COVID-19 and stroke were younger (pooled median difference = -6.0 years; 95%CI: -12.3 to -1.4), had higher NIHSS (pooled median difference = 5; 95%CI: 3-9), higher frequency of large vessel occlusion (OR = 2.73; 95%CI: 1.63-4.57), and higher in-hospital mortality rate (OR = 5.21; 95%CI: 3.43-7.90).

CONCLUSIONS

Acute cerebrovascular diseases are not uncommon in patients with COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors. The pattern of large vessel occlusion and multi-territory infarcts suggests that cerebral thrombosis and/or thromboembolism could be possible causative pathways for the disease.

摘要

背景

2019 年冠状病毒病（COVID-19）已成为全球大流行疾病，影响了数百万人。然而，COVID-19 与急性脑血管疾病之间的关系尚不清楚。

目的

我们旨在描述 COVID-19 相关卒中的发病率、危险因素、临床-影像学表现和结局。

方法

我们系统性地检索了 3 个医学数据库中有关 COVID-19 急性脑血管疾病的已发表文献（2019 年 12 月至 2020 年 9 月）。该综述方案已预先注册（PROSPERO ID = CRD42020185476）。我们从报告 COVID-19 中≥5 例卒中病例的文章中提取数据。我们遵循 PRISMA 指南，并使用纽卡斯尔-渥太华量表评估数据质量。使用随机效应模型对数据进行汇总。

综述总结

在最初确定的 2277 篇文章中，有 61 篇（2.7%）被纳入荟萃分析。在 108571 例 COVID-19 患者中，急性心血管疾病的发生率为 1.4%（95%CI：1.0-1.9）。最常见的表现为急性缺血性卒中（87.4%）；脑出血较少见（11.6%）。与未发生急性脑血管疾病的 COVID-19 患者相比，发生急性脑血管疾病的 COVID-19 患者年龄更大（汇总中位数差异=4.8 岁；95%CI：1.7-22.4），更可能患有高血压（OR=7.35；95%CI：1.94-27.87）、糖尿病（OR=5.56；95%CI：3.34-9.24）、冠状动脉疾病（OR=3.12；95%CI：1.61-6.02）和严重感染（OR=5.10；95%CI：2.72-9.54）。与未感染 COVID-19 的卒中患者相比，COVID-19 合并卒中患者的年龄更小（汇总中位数差异=-6.0 岁；95%CI：-12.3 至-1.4），NIHSS 评分更高（汇总中位数差异=5；95%CI：3-9），大血管闭塞的频率更高（OR=2.73；95%CI：1.63-4.57），院内死亡率更高（OR=5.21；95%CI：3.43-7.90）。