Department of Neurology, Yan'an University Affiliated Hospital, Yan'an, Shaanxi, China.
Department of Medical Laboratory, Yan'an University Affiliated Hospital, Yan'an, Shaanxi, China.
Medicine (Baltimore). 2024 Sep 27;103(39):e39761. doi: 10.1097/MD.0000000000039761.
To evaluate the differences in short-term mortality risk between acute ischemic stroke (AIS) patients with and without SARS-CoV-2 infection.
PubMed, EMBASE, Scopus, and Cochrane Databases were systematically searched from December 1, 2019 to May 20, 2022 using the keywords coronavirus disease 2019 (COVID-19), COVID-19, SARS-CoV-2, and ischemic stroke. A random-effects model was estimated, and subgroup analysis and meta-regressions were performed. The quality of eligible studies was assessed using the Newcastle-Ottawa Scale.
A total of 26 eligible studies with 307,800 patients were included in this meta-analysis. The overall results show that in-hospital and 90-day mortality was 3.31-fold higher in AIS with SARS-CoV-2 patients compared with those without SARS-CoV-2. When matched for age and National Institutes of Health Stroke Scale score at admission, the risk ratio of in-hospital mortality from AIS among patients with SARS-CoV-2 versus without decreased to 2.83. Reperfusion therapy and endovascular thrombectomy may further reduce the risk of death in patients to some extent but do not increase the incidence of symptomatic intracerebral hemorrhage. Meta-regression showed that in-hospital mortality decreased with increasing National Institutes of Health Stroke Scale score in AIS with SARS-CoV-2 compared to those without SARS-CoV-2 and that the difference in mortality risk between the 2 was independent of age and sex.
The results of this study suggest that AIS patients with SARS-CoV-2 have higher short-term mortality compared to AIS patients without SARS-CoV-2, and reperfusion and endovascular thrombectomy therapy may reduce the risk of short-term mortality to some extent. The differences in in-hospital mortality risk were similar across ages and sexes. Focused attention is therefore needed on AIS patients with SARS-CoV-2 to control mortality.
评估伴有和不伴有严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的急性缺血性脑卒中（AIS）患者短期死亡率风险的差异。
系统检索了 2019 年 12 月 1 日至 2022 年 5 月 20 日的 PubMed、EMBASE、Scopus 和 Cochrane 数据库，使用的关键词包括冠状病毒病 2019（COVID-19）、COVID-19、SARS-CoV-2 和缺血性脑卒中。采用随机效应模型进行估计，并进行亚组分析和荟萃回归分析。使用纽卡斯尔-渥太华量表评估合格研究的质量。
本荟萃分析共纳入 26 项符合条件的研究，共纳入 307800 例患者。总体结果显示，伴有 SARS-CoV-2 的 AIS 患者住院期间和 90 天死亡率比不伴有 SARS-CoV-2 的患者高 3.31 倍。当按入院时年龄和美国国立卫生研究院卒中量表评分匹配时，伴有 SARS-CoV-2 的 AIS 患者住院期间死亡率的风险比降低至 2.83。再灌注治疗和血管内血栓切除术可能在一定程度上进一步降低患者的死亡风险，但不会增加症状性颅内出血的发生率。荟萃回归分析显示，与不伴有 SARS-CoV-2 的 AIS 患者相比，伴有 SARS-CoV-2 的 AIS 患者的住院期间死亡率随美国国立卫生研究院卒中量表评分的增加而降低，并且 2 者之间的死亡率风险差异与年龄和性别无关。
本研究结果表明，与不伴有 SARS-CoV-2 的 AIS 患者相比，伴有 SARS-CoV-2 的 AIS 患者短期死亡率更高，再灌注和血管内血栓切除术治疗可能在一定程度上降低短期死亡率风险。住院期间死亡率风险的差异在年龄和性别之间相似。因此，需要重点关注伴有 SARS-CoV-2 的 AIS 患者，以控制死亡率。
