The impact of SARS-COV-2 on stroke epidemiology and care: A meta-analysis

Background: Emerging data indicates an increased risk for cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and highlights the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke We conducted a systematic review and meta-analysis to evaluate the aforementioned considerations Methods: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARSCoV- 2 infection status We used a random-effects model Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (95%CI) Results: We identified 16 cohort studies including 44,004 patients Among patients with SARS-CoV- 2, 1 3% (95%CI: 0 9-1 8%;I =88%) were hospitalized for cerebrovascular events, 1 2% (95%CI: 0 8-1 5%;I =85%) for ischemic stroke, and 0 2% (95%CI: 0 1-0 4%;I =69%) for hemorrhagic stroke Compared to non-infected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR=3 58, 95%CI: 1 43-8 92;I =43%) and cryptogenic stroke (OR=3 98, 95%CI: 1 62-9 77;I =0%) Odds for in-hospital mortality were higher among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical stroke patients (OR=5 60, 95%CI: 3 19-9 80;I =45%) SARS-CoV-2 infection status was not associated to the likelihood of receiving intravenous thrombolysis (OR=1 42, 95%CI: 0 65-3 10;I =0%) or endovascular thrombectomy (OR=0 78, 95%CI: 0 35-1 74;I =0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to non-infected contemporary or historical controls(OR=1 39, 95%CI: 1 04-1 86;I =0%) Conclusion: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke,particularly the cryptogenic subtype SARS-CoV-2 infection in stroke substantially increases themortality risk