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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Acute ischemic stroke outcomes in patients with COVID-19: a systematic review and meta-analysis
Sophia R Ferrone1, Maria X Sanmartin1,2, Joseph Ohara3
1Institute for Health System Science, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA.
Insights
Patients with acute ischemic stroke (AIS) and COVID-19 have significantly worse outcomes. This includes nearly fourfold increased mortality, reduced functional recovery, and less likelihood of returning home. COVID-19 substantially impacts early stroke prognosis.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- COVID-19 is associated with an increased risk of acute ischemic stroke (AIS).
- The precise impact of COVID-19 on the clinical outcomes of AIS patients remains incompletely understood.
- Understanding these outcomes is crucial for patient management and public health strategies.
Approach:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- Searches were performed across major databases (EMBASE, PubMed, Web-of-Science, Scopus, CINAHL) up to June 3, 2021.
- Random-effects models were used to pool data on mortality, functional outcomes (mRS), length of stay, and discharge disposition.
Key Points:
- AIS patients with COVID-19 (AIS-COVID+) exhibited significantly higher in-hospital mortality compared to those without COVID-19 (AIS-COVID-).
- AIS-COVID+ patients had poorer functional outcomes, indicated by lower rates of modified Rankin Scale (mRS) scores of 0-2.
- These patients also experienced longer hospital stays and were less likely to be discharged to their homes.
Conclusions:
- COVID-19 significantly worsens early outcomes for patients experiencing acute ischemic stroke.
- The findings highlight a nearly fourfold increase in mortality and substantially reduced odds of favorable functional recovery and home discharge.
- These results underscore the critical need for integrated care pathways for stroke patients with concurrent COVID-19 infections.
Background:
Although patients with COVID-19 have a higher risk of acute ischemic stroke (AIS), the impact on stroke outcomes remains uncertain.
Aims:
To determine the clinical outcomes of patients with AIS and COVID-19 (AIS-COVID+).
Methods:
We 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.
Results:
Of 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).
Conclusions:
Patients 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.
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