Relationship between the history of cerebrovascular disease and mortality in COVID-19 patients: A systematic review and meta-analysis

Florez-Perdomo, William Andrés; Serrato-Vargas, Sergio Andrés; Bosque-Varela, Pilar; Moscote-Salazar, Luis Rafael; Joaquim, Andrei Fernandes; Agrawal, Amit; Soto-Angel, Álvaro Ricardo; Tovar-Montenegro, Leidy Tatiana

doi:10.1016/j.clineuro.2020.106183

Cited by 12 publications

(8 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this cohort, the majority of patients with a prior cerebrovascular disease had a prior acute ischemic stroke (9.9%; 11/1,128), a prevalence which was higher than expected from U.S. 2013–2016 stroke estimates of 2.5% for adults ages > 20 years old ( 14 ). These results are consistent with published cohorts suggesting a greater number of hospitalized COVID-19 patients with cerebrovascular disease than prevalence estimates and increased likelihood of negative outcomes ( 4 , 8 , 10 – 13 , 16 , 17 , 21 , 28 – 31 ). The findings presented here extends our understanding of comorbidities that may contribute to increased risk of critical illness in COVID-19, and additionally suggests that critically ill COVID-19 patients with cerebrovascular disease may be prone to longer mechanical ventilation time than patients of similar ages and demographics without cerebrovascular disease.…”

Section: Discussionsupporting

confidence: 91%

“…Our understanding of the risk of COVID-19 critical illness due to chronic neurological conditions remains limited, with cohorts from Asia and Europe suggesting a history of ischemic or hemorrhagic stroke as risk factors for severe events such as mechanical ventilation (MV) ( 8 ) and death ( 8 , 10 ). Recently, two meta-analyses reviewed the relationship between the prior cerebrovascular disease and in-hospital outcomes in COVID-19, using data derived from Chinese and European cohorts, and suggested an increase in risk for critical illness ( 16 ) and mortality ( 17 ) among patients with prior cerebrovascular disease.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19

et al. 2021

View full text Add to dashboard Cite

Objectives: Patients with comorbidities are at increased risk for poor outcomes in COVID-19, yet data on patients with prior neurological disease remains limited. Our objective was to determine the odds of critical illness and duration of mechanical ventilation in patients with prior cerebrovascular disease and COVID-19.Methods: A observational study of 1,128 consecutive adult patients admitted to an academic center in Boston, Massachusetts, and diagnosed with laboratory-confirmed COVID-19. We tested the association between prior cerebrovascular disease and critical illness, defined as mechanical ventilation (MV) or death by day 28, using logistic regression with inverse probability weighting of the propensity score. Among intubated patients, we estimated the cumulative incidence of successful extubation without death over 45 days using competing risk analysis.Results: Of the 1,128 adults with COVID-19, 350 (36%) were critically ill by day 28. The median age of patients was 59 years (SD: 18 years) and 640 (57%) were men. As of June 2nd, 2020, 127 (11%) patients had died. A total of 177 patients (16%) had a prior cerebrovascular disease. Prior cerebrovascular disease was significantly associated with critical illness (OR = 1.54, 95% CI = 1.14–2.07), lower rate of successful extubation (cause-specific HR = 0.57, 95% CI = 0.33–0.98), and increased duration of intubation (restricted mean time difference = 4.02 days, 95% CI = 0.34–10.92) compared to patients without cerebrovascular disease.Interpretation: Prior cerebrovascular disease adversely affects COVID-19 outcomes in hospitalized patients. Further study is required to determine if this subpopulation requires closer monitoring for disease progression during COVID-19.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The baseline characteristics associated with mortality observed in this study were in line with the findings of other studies, such as a higher proportion of deaths in older patients, higher Charlson comorbidity index value, and history of stroke 3 , 9 - 10 . We also found a higher proportion of deaths in patients who lived in nursing homes (60%), in accordance with studies carried out in Brazil and other countries, which highlighted the high vulnerability of patients residing in nursing homes 11 .…”

supporting

confidence: 91%

Risk factors associated with mortality in patients hospitalized for coronavirus disease 2019 in Rio de Janeiro, Brazil

Correal¹,

Solórzano

Damasco

et al. 2021

Rev. Soc. Bras. Med. Trop.

View full text Add to dashboard Cite

Introduction: Understanding the mortality-associated risk factors of coronavirus disease 2019 will impact clinical decisions. Methods: This retrospective longitudinal study included patients hospitalized for coronavirus disease in Rio de Janeiro, Brazil. The Kaplan-Meier method and multivariate Cox regression analysis were used. Results: Sequential Organ Failure Assessment score of ≥2 (hazard ratio 4.614; 95% confidence interval =2.210-9.634; p<0.001) and neutrophil/lymphocyte ratio of >5 (hazard ratio=2.616; 95% confidence interval=1.303-5.252; p=0.007) were independently associated with mortality. Conclusions: Sequential Organ Failure Assessment score and neutrophil/lymphocyte ratio on admission can identify coronavirus disease patients at increased risk of death and guide subsequent clinical decisions.

show abstract

“…Nine reviews which were rated as moderate quality examined associations between cerebrovascular disease and outcomes with COVID-19. 21 , 23 , 25 , 31 , 38 , 39 , 44 , 46 , 48 The moderate quality review with the largest number of studies reported cerebrovascular disease was associated with a significant 2.75 times higher risk of mortality [pooled relative risk (RR) 2.75 (1.54–4.89), n = 11 studies, considerable heterogeneity ( I 2 = 99%)]. 39 The review by Fang et al ., 23 was also rated moderate quality and included the largest number of studies examining the association between cerebrovascular disease and severe COVID-19.…”

Section: Resultsmentioning

confidence: 99%

Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews

Harrison

Buckley

Rivera‐Caravaca

et al. 2021

European Heart Journal - Quality of Care and Clinical Outcomes

View full text Add to dashboard Cite

Aims To consolidate evidence to determine (i) the association between cardiovascular risk factors and health outcomes with coronavirus 2019 (COVID-19); and (ii) the impact of COVID-19 on cardiovascular health. Methods and results An umbrella review of systematic reviews was conducted. Fourteen medical databases and pre-print servers were searched from 1 January 2020 to 5 November 2020. The review focused on reviews rated as moderate or high-quality using the AMSTAR 2 tool. Eighty-four reviews were identified; 31 reviews were assessed as moderate quality and one was high-quality. The following risk factors were associated with higher mortality and severe COVID-19: renal disease [odds ratio (OR) (95% confidence interval) for mortality 3.07 (2.43–3.88)], diabetes mellitus [OR 2.09 (1.80–2.42)], hypertension [OR 2.50 (2.02–3.11)], smoking history [risk ratio (RR) 1.26 (1.20–1.32)], cerebrovascular disease [RR 2.75 (1.54–4.89)], and cardiovascular disease [OR 2.65 (1.86–3.78)]. Liver disease was associated with higher odds of mortality [OR 2.81 (1.31–6.01)], but not severe COVID-19. Current smoking was associated with a higher risk of severe COVID-19 [RR 1.80 (1.14–2.85)], but not mortality. Obesity associated with higher odds of mortality [OR 2.18 (1.10–4.34)], but there was an absence of evidence for severe COVID-19. In patients hospitalized with COVID-19, the following incident cardiovascular complications were identified: acute heart failure (2%), myocardial infarction (4%), deep vein thrombosis (7%), myocardial injury (10%), angina (10%), arrhythmias (18%), pulmonary embolism (19%), and venous thromboembolism (25%). Conclusion Many of the risk factors identified as associated with adverse outcomes with COVID-19 are potentially modifiable. Primary and secondary prevention strategies that target cardiovascular risk factors may improve outcomes for people following COVID-19.

show abstract

Relationship between the history of cerebrovascular disease and mortality in COVID-19 patients: A systematic review and meta-analysis

Abstract: Highlights Cerebrovascular disease as a risk factor for COVID-19 mortality. Future studies will allow the development of risk scales in patients with COD19 and a history of stroke. More clinical trials are need to explore the effect of history of stroke and COVID19.

Cited by 12 publications

References 19 publications

Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19

Prolonged Intubation in Patients With Prior Cerebrovascular Disease and COVID-19

Risk factors associated with mortality in patients hospitalized for coronavirus disease 2019 in Rio de Janeiro, Brazil

Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews

Contact Info

Product

Resources

About