Stroke and COVID-19: An Umbrella Review

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• COVID-19 has been linked to acute cerebrovascular diseases (CVDs), including acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH).
• Understanding the precise incidence and outcomes of stroke in COVID-19 patients is crucial for clinical management and public health strategies.

Purpose of the Study:

• To systematically compile and analyze existing data on the incidence, characteristics, and outcomes of stroke in patients with COVID-19.
• To provide a comprehensive overview of stroke risk and patient outcomes associated with COVID-19.

Main Methods:

• A systematic review and meta-analysis of 23 meta-analyses, including 795 articles and 5,937 patients.
• Searched multiple databases (PubMed, Scopus, Web of Knowledge, Embase, Cochrane) and conducted manual searches, reference checks, and gray literature review.
• Assessed reporting quality using the AMSTAR checklist and performed meta-analysis using Stata software.

Main Results:

• The collective incidence of stroke in COVID-19 patients was approximately 1.75% (Ischemic: 1.59%, Hemorrhagic: 0.3%).
• The average age of affected patients was 62.3 years, with 68.3% being male. Ischemic strokes constituted nearly 80% of cases.
• Mortality rate was 32.3%; 27% were discharged with mild/no complications, and 28.1% required rehabilitation.

Conclusions:

• COVID-19 is associated with a notable incidence of stroke, particularly ischemic stroke, in a population with a mean age of 62.3 years and a male predominance.
• A significant proportion of COVID-19 patients experiencing stroke face mortality (32.3%), highlighting the severity of this complication.
• While a substantial percentage of patients recover without complications or require rehabilitation, the overall impact underscores the need for vigilance in managing cerebrovascular risks during COVID-19 infection.