Association of history of cerebrovascular disease with severity of COVID-19

Abstract

Objective To determine whether a history of cerebrovascular disease (CVD) increases risk of severe coronavirus disease 2019 (COVID-19). Methods In a retrospective multicenter study, we retrieved individual data from in-patients treated March 1 to April 15, 2020 from COVID-19 registries of three hospitals in Saxony, Germany. We also performed a systematic review and metaanalysis following PRISMA recommendations using PubMed, EMBASE, Cochrane Library databases and bibliographies of identified papers (last search on April 11, 2020) and pooled data with those deriving from our multicenter study. Of 3762 records identified, 11 eligible observational studies of laboratory-confirmed COVID-19 patients were included in quantitative data synthesis. Risk ratios (RR) of severe COVID-19 according to history of CVD were pooled using DerSimonian and Laird random effects model. Between-study heterogeneity was assessed using Cochran's Q and I2-statistics. Severity of COVID-19 according to definitions applied in included studies was the main outcome. Sensitivity analyses were conducted for clusters of studies with equal definitions of severity. Results Pooled analysis included data from 1906 laboratory-confirmed COVID-19 patients (43.9% females, median age ranging from 39 to 76 years). Patients with previous CVD had higher risk of severe COVID-19 than those without [RR 2.07, 95% confidence interval (CI) 1.52-2.81; p < 0.0001]. This association was also observed in clusters of studies that defined severe manifestation of the disease by clinical parameters (RR 1.44, 95% CI 1.22-1.71; p < 0.0001), necessity of intensive care (RR 2.79, 95% CI 1.83-4.24; p < 0.0001) and in-hospital death (RR 2.18, 95% CI 1.75-2.7; p < 0.0001). Conclusion A history of CVD might constitute an important risk factor of unfavorable clinical course of COVID-19 suggesting a need of tailored infection prevention and clinical management strategies for this population at risk.

COVID-19 and cerebrovascular diseases: a comprehensive overview

“…50,105 In addition, a previous history of stroke was an independent risk factor for severe pneumonia leading to critical illness, the need for ventilation, and mortality in COVID-19 patients. 126,127…”

Psychological and neuropsychiatric implications of COVID-19

“…This results in highly increased D-dimer fibrin, which is now considered to be a risk factor of disease severity and mortality [73]. Indeed, COVID 19 patients with a previous history of cerebrovascular disease have higher risk of severe COVID-19 than those without (RR 2.07] [74]) and 2.67 higher odds for poor outcome, including the need for intensive care admission and mechanical ventilation, as well as higher rate of mortality [75].…”

Covid-19 Enfeksiyonunda Perkütan Endoskopik Gastrostomi Zamanlaması: Endoskopik Cerrahi Ünite Deneyimi

“…In our study, there was a strong association between virus-infected patients who underwent PEG and COVID-19. The literature suggests that COVID-19 may be more severe in individuals with a history of COVID-19 and describes the effects of accompanying cardiovascular diseases in these patients [14]. Morbidity and mortality rates are higher in COVID-19 infected patients with comorbidities such as diabetes, cardiovascular disease, chronic respiratory diseases, and in patients over the age of 60 [15].…”