Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada.
Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Ann Neurol. 2021 Feb;89(2):380-388. doi: 10.1002/ana.25967. Epub 2020 Dec 9.
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.
越来越多的数据表明，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）与脑血管事件风险增加有关，并强调了冠状病毒病（COVID-19）对急性中风的管理和结局的潜在影响。我们进行了系统评价和荟萃分析来评估上述考虑因素。
我们对报告与 SARS-CoV-2 感染状态相关的脑血管事件发生和/或结局的观察性队列研究进行荟萃分析。我们使用随机效应模型。汇总估计值以优势比（OR）和相应的 95%置信区间（CI）报告。
我们确定了 18 项队列研究，共纳入 67845 名患者。在 SARS-CoV-2 患者中，1.3%（95%CI=0.9-1.6%，I=87%）因脑血管事件住院，1.1%（95%CI=0.8-1.3%，I=85%）因缺血性中风住院，0.2%（95%CI=0.1-0.3%，I=64%）因出血性中风住院。与未感染的同期或历史对照相比，SARS-CoV-2 感染患者发生缺血性中风（OR=3.58，95%CI=1.43-8.92，I=43%）和隐源性中风（OR=3.98，95%CI=1.62-9.77，I=0%）的几率更高。与未感染的历史对照相比，SARS-CoV-2 中风患者中糖尿病更为普遍（OR=1.39，95%CI=1.00-1.94，I=0%）。在 COVID-19 大流行期间，住院的缺血性中风患者接受静脉溶栓（OR=1.42，95%CI=0.65-3.10，I=0%）或血管内血栓切除术（OR=0.78，95%CI=0.35-1.74，I=0%）的可能性与 SARS-CoV-2 感染状况无关。与未感染的同期或历史中风患者相比，SARS-CoV-2 中风患者的住院死亡率更高（OR=5.60，95%CI=3.19-9.80，I=45%）。
SARS-CoV-2 似乎与缺血性中风风险增加有关，特别是可能与隐源性中风有关。它还可能与更高的死亡率风险有关。
