In patients hospitalized with coronavirus disease 2019 (COVID-19), stroke was associated with those who were older and presented with stroke risk factors. They were found to have a slightly higher frequency of stroke compared with the estimation for the general population, according to study results published in the Journal of Stroke and Cerebrovascular Diseases.
Study researchers sought to investigate the frequency and clinical characteristics of patients with both COVID-19 and stroke. This analysis was a systematic review of observational studies, case series, and case reports that disclosed the incidence of ischemic or hemorrhagic stroke in patients with COVID-19. In total, 10 retrospective cohort studies, 10 case reports, and 6 case series were included in the final meta-analysis. A pooled cohort of 183 patients with both COVID-19 and stroke were assessed.
Among the 6368 hospitalized patients with COVID-19, the reported frequency of stroke was 1.1% (95% CI, 95% CI, 0.6-1.6; I2=62.9%). The mean age of the study cohort was 66.6 years (95% CI, 58.4-74.9; I2=95.2%), and over half of the patients were men (65.6%). Comorbidities included hypertension (69.4%), dyslipidemia (44.4%), diabetes (43.5%), acute coronary syndrome/coronary artery disease (26.9%), atrial fibrillation (23.1%), prior stroke/transient ischemic attack (10.4%), and malignancy (14.8%).
In patients who had data describing their stroke type, approximately 96.6% had ischemic stroke. The mean number of days from the onset of COVID-19 symptoms to stroke was 8 days (95% CI, 4.1-11.9; I2=93.1%; I2=93.1%; P <.001). The mean D-dimer was 3.3 µg/mL (95%CI, 1.7-4.9; I2=86.3%), and the mean C-reactive protein level was 127.8 mg/L (95% CI, 100.9-154.6; I2=0%).
In 50.7% of patients, the etiology of stroke was cryptogenic (95% CI, 31.0-70.4; I2=64.1%). Among 100 patients, the case fatality rate was 44.2% (95% CI, 27.9-60.5; I2=66.7%).
Limitations of this study included the small sample size, potential publication bias in the included case reports and series, and the presence of considerable heterogeneity in the pooled patient population.
The study researchers concluded that additional studies could be “helpful to decipher the pathophysiology and prognosis of stroke in COVID-19 to achieve the most effective care for this population to decrease mortality.”
Yamakawa M, Kuno T, Mikami T, Takagi H, Gronseth G. Clinical characteristics of stroke with COVID-19: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2020;29(12):105288. doi:10.1016/j.jstrokecerebrovasdis.2020.105288