Journal Article

Acute ischemic stroke outcomes in patients with COVID-19: a systematic review and meta-analysis

Ohara, Joseph, Wang, Jason J, Feizullayeva, Chinara, Lodato, Zachary, Vialet, Jaclyn Morales, Shahsavarani, Shaya, Lacher, Gregory, Demissie, Seleshi, Jimenez, Jean C, Sanelli, Pina C, Sanmartin, Maria X, Ferrone, Sophia R, White, Tim G, Katz, Jeffrey M

2024

Overview

BackgroundAlthough patients with COVID-19 have a higher risk of acute ischemic stroke (AIS), the impact on stroke outcomes remains uncertain.AimsTo determine the clinical outcomes of patients with AIS and COVID-19 (AIS-COVID+).MethodsWe performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Our protocol was registered with the International Prospective Register of Systematic Reviews (CRD42020211977). Systematic searches were last performed on June 3, 2021 in EMBASE, PubMed, Web-of-Science, Scopus, and CINAHL Databases. Inclusion criteria: (1) studies reporting outcomes on AIS-COVID+; (2) original articles published in 2020 or later; (3) study participants aged ≥18 years. Exclusion criteria: (1) case reports with <5 patients, abstracts, review articles; (2) studies analyzing novel interventions. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Random-effects models estimated the pooled OR and 95% confidence intervals (95% CI) for mortality, modified Rankin Scale (mRS) score, length of stay (LOS), and discharge disposition.ResultsOf the 43 selected studies, 46.5% (20/43) reported patients with AIS without COVID-19 (AIS-COVID−) for comparison. Random-effects model included 7294 AIS-COVID+ and 158 401 AIS-COVID−. Compared with AIS-COVID−, AIS-COVID+ patients had higher in-hospital mortality (OR=3.87 (95% CI 2.75 to 5.45), P<0.001), less mRS scores 0–2 (OR=0.53 (95% CI 0.46 to 0.62), P<0.001), longer LOS (mean difference=4.21 days (95% CI 1.96 to 6.47), P<0.001), and less home discharge (OR=0.31 (95% CI 0.21 to 0.47), P<0.001).ConclusionsPatients with AIS-COVID had worse outcomes, with almost fourfold increased mortality, half the odds of mRS scores 0–2, and one-third the odds of home discharge. These findings confirm the significant impact of COVID-19 on early stroke outcomes.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Adolescent / Adult / Clinical outcomes / COVID-19 / Hospital Mortality / Hospitals / Humans / Ischemia / Ischemic Stroke - therapy / Length of stay / Maximum likelihood method / Meta-analysis / Mortality / Pandemics / Patients / Software / Stroke / Stroke - therapy / Systematic review / The pandemic and neurointervention