The association between stroke and COVID-19-related mortality: a systematic review and meta-analysis based on adjusted effect estimates

Li, Shuwen; Ren, Jiahao; Hou, Hongjie; Han, Xueya; Xu, Jie; Duan, Guangcai; Wang, Yadong; Yang, Haiyan

doi:10.1007/s10072-022-06024-9

Cited by 12 publications

(8 citation statements)

References 68 publications

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“…Considering the methodological quality of AMSTAR-2 tool items, 15 [6,8,[14][15][16][17][18][19][20][21][22][23][24][25][26] and 1 [27] studies were rated as being of high and moderate quality, respectively. Overall, 16 [7,24,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] and 12 [5,[42][43][44][45][46][47][48][49][50][51][52] studies were rated as being of low and critically low quality (online suppl. Material S3 Table 1).…”

Section: Study Identification and Characteristicsmentioning

confidence: 99%

Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence

et al. 2023

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Introduction: Coronavirus disease 2019 (COVID-19), a global pandemic, has infected approximately 10% of the world's population. This comprehensive review aims to determine the prevalence of various neurological disorders in COVID-19 without overlapping meta-analysis errors. Methods: We searched for meta-analyses on neurologic disorders following COVID-19 published up to March 14, 2023. We obtained 1,184 studies, of which 44 meta-analyses involving 9,228,588 COVID-19 patients were finally included. After confirming the forest plot of each study and removing overlapping individual studies, a re-meta-analysis was performed using the random effect model. Results: The summarized combined prevalence of each neurological disorder is as follows: stroke 3.39%(95% confidence interval, 1.50-5.27), dementia 6.41%(1.36-11.46), multiple sclerosis 4.00%(2.50-5.00), epilepsy 5.36%(-0.60-11.32), Parkinson's disease 0.67%(-1.11-2.45), encephalitis 0.66%(-0.44-1.77) and Guillain–Barré syndrome 3.83%(-0.13-7.80). In addition, the mortality risk of patients with co-morbidities of COVID-19 is as follows: stroke OR 1.63(1.23-2.03), epilepsy OR 1.71(1.00-2.42), dementia OR 1.90(1.31-2.48), Parkinson's disease OR 3.94(-2.12-10.01). Conclusion: Our results show that the prevalence and mortality risk may increase in some neurological diseases during the COVID-19 pandemic. Future studies should elucidate the precise mechanisms for the link between COVID-19 and neurological diseases, determine which patient characteristics predispose them to neurological diseases, and consider potential global patient management.

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Section: Study Identification and Characteristicsmentioning

confidence: 99%

Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence

et al. 2023

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“…A total of 13 meta-analyses reported the association between preexisting cerebrovascular disease and severe COVID-19. Two studies reported the effect of previous stroke on severe COVID-19 ( 34 , 46 ). One study ( 31 ) reported both cerebrovascular disease and stroke as exposures.…”

Section: Resultsmentioning

confidence: 99%

Association Between Previous Stroke and Severe COVID-19: A Retrospective Cohort Study and an Overall Review of Meta-Analysis

et al. 2022

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ObjectiveThe objective of this study was to investigate the association between previous stroke and the risk of severe coronavirus disease 2019 (COVID-19).MethodsWe included 164 (61.8 ± 13.6 years) patients with COVID-19 in a retrospective study. We evaluated the unadjusted and adjusted associations between previous stroke and severe COVID-19, using a Cox regression model. We conducted an overall review of systematic review and meta-analysis to investigate the relationship of previous stroke with the unfavorable COVID-19 outcomes.ResultsThe rate of severe COVID-19 in patients with previous stroke was 28.37 per 1,000 patient days (95% confidence interval [CI]: 10.65–75.59), compared to 3.94 per 1,000 patient days (95% CI: 2.66–5.82) in those without previous stroke (p < 0.001). Previous stroke was significantly associated with severe COVID-19 using a Cox regression model (unadjusted [hazard ratio, HR]: 6.98, 95% CI: 2.42–20.16, p < 0.001; adjusted HR [per additional 10 years]: 4.62, 95% CI: 1.52–14.04, p = 0.007). An overall review of systematic review and meta-analysis showed that previous stroke was significantly associated with severe COVID-19, mortality, need for intensive care unit admission, use of mechanical ventilation, and an unfavorable composite outcome.ConclusionPrevious stroke seems to influence the course of COVID-19 infection; such patients are at high risk of severe COVID-19 and might benefit from early hospital treatment measures and preventive strategies.

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“…Study-level data were meta-analyzed in the majority of included SLRs (28 of 35 (80%)) even though high heterogeneity (I2 > 70%) was observed in > 90% of pooled effect estimates. Meta-regression was not commonly presented (7 of 28 meta-analyses 24,26,33,[36][37][38]41 ) with age and sex as the most frequently used adjusted factors. Furthermore, only one SLR, including hospitalized children and young people, attempted to identify individual patient data from the included studies and conducted a multilevel meta-analysis adjusting for age and sex.…”

Section: Characteristics Of Slrs Published Between January 2022 and A...mentioning

confidence: 99%

Prognostic Factors of COVID‐19: An Umbrella Review Endorsed by the International Society for Pharmacoepidemiology

Sarri¹,

Liu

Zabotka

et al. 2023

Clin Pharma and Therapeutics

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During the coronavirus disease 2019 (COVID‐19) pandemic, the urgency for updated evidence to inform public health and clinical care placed systematic literature reviews (SLRs) at the cornerstone of research. We aimed to summarize evidence on prognostic factors for COVID‐19 outcomes through published SLRs and to critically assess quality elements in the findings' interpretation. An umbrella review was conducted via electronic databases from January 2020 to April 2022. All SLRs (and meta‐analyses) in English were considered. Data screening and extraction were conducted by two independent reviewers. AMSTAR 2 tool was used to assess SLR quality. The study was registered with PROSPERO (CRD4202232576). Out of 4,564 publications, 171 SLRs were included of which 3 were umbrella reviews. Our primary analysis included 35 SLRs published in 2022, which incorporated studies since the beginning of the pandemic. Consistent findings showed that, for adults, older age, obesity, heart disease, diabetes, and cancer were more strongly predictive of risk of hospitalization, intensive care unit admission, and mortality due to COVID‐19. Male sex was associated with higher risk of short‐term adverse outcomes, but female sex was associated with higher risk of long COVID. For children, socioeconomic determinants that may unravel COVID‐19 disparities were rarely reported. This review highlights key prognostic factors of COVID‐19, which can help clinicians and health officers identify high‐risk groups for optimal care. Findings can also help optimize confounding adjustment and patient phenotyping in comparative effectiveness research. A living SLR approach may facilitate dissemination of new findings. This paper is endorsed by the International Society for Pharmacoepidemiology.

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The association between stroke and COVID-19-related mortality: a systematic review and meta-analysis based on adjusted effect estimates

Cited by 12 publications

References 68 publications

Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence

Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence

Association Between Previous Stroke and Severe COVID-19: A Retrospective Cohort Study and an Overall Review of Meta-Analysis

Prognostic Factors of COVID‐19: An Umbrella Review Endorsed by the International Society for Pharmacoepidemiology

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