Cerebrovascular disease in COVID-19: Is there a higher risk of stroke?

Altable, Marcos; Serna, Juan Moisés de la

doi:10.1016/j.bbih.2020.100092

Cited by 28 publications

(22 citation statements)

References 34 publications

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“…Previous reports have been published with the attempt to clarify the relationship between stroke and COVID-19. These included narrative reviews, 32 , 33 systematic reviews, 9 – 11 , 34 and meta-analyses. 34 , 35 While some authors have focused on the relationship between personal history of CVD and COVID-19, 7 , 8 we studied the incidence and risk factors for the occurrence of new CVD in concomitant SARS-CoV2 infection, searching for a specific profile of COVID-19-associated stroke.…”

Section: Discussionmentioning

confidence: 99%

Stroke in COVID-19: A systematic review and meta-analysis

Nannoni

Groot

Bell

et al. 2020

International Journal of Stroke

478

496

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Background: Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases (CVD) is unclear. Aims: We aimed to characterize the incidence, risk factors, clinical-radiological manifestations and outcome of COVID-19-associated stroke. Methods: Three medical databases were systematically reviewed for published articles on acute CVD in COVID-19 (December 2019-September 2020). The review protocol was previously registered (PROSPERO ID=CRD42020185476). Data were extracted from articles reporting ï³5 stroke cases in COVID-19. We complied with the PRISMA guidelines, and used the NewcastleâOttawa Scale to assess data quality. Data were pooled using a random-effects model. Summary of review: Of 2,277 initially identified articles, 61 (2.7%) were entered in the meta-analysis. Out of 108,571 patients with COVID-19, acute CVD occurred in 1.4% (95%CI: 1.0-1.9). The most common manifestation was acute ischemic stroke (87.4%); intracerebral haemorrhage was less common (11.6%). Patients with COVID-19 developing acute CVD, compared to those who did not, were older (pooled median difference=4.8 years; 95%CI:1.7-22.4), more likely to have hypertension (OR=7.35; 95%CI:1.94-27.87), diabetes mellitus (OR=5.56; 95%CI:3.34-9.24), coronary artery disease (OR=3.12; 95%CI:1.61-6.02), and severe infection (OR=5.10; 95%CI:2.72-9.54). Compared to individuals who experienced a stroke without the infection, patients with COVID-19 and stroke were younger (pooled median difference=-6.0 years; 95%CI:-12.3 to -1.4), had higher NIHSS (pooled median difference=5; 95%CI:3-9), higher frequency of large vessel occlusion (OR=2.73; 95%CI:1.63-4.57), and higher in-hospital mortality rate (OR=5.21; 95% CI:3.43-7.90). Conclusions: Acute CVD is not uncommon in COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors. The pattern of large vessel occlusion and multi-territory infarcts suggest that cerebral thrombosis and/or thromboembolism could be possible causative pathways for the disease.

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Section: Discussionmentioning

confidence: 99%

Stroke in COVID-19: A systematic review and meta-analysis

Nannoni

Groot

Bell

et al. 2020

International Journal of Stroke

478

496

View full text Add to dashboard Cite

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“…Thus, when applying those factors along with the selected measurement variables, we saw that cerebrovascular disease, pulmonary disease, renal disease, and increased eosinophil count were associated with the worse prognosis of COVID-19. Studies have found that COVID-19 infection can accelerate the development of cerebrovascular disease; previously published autopsy results of COVID-19 patients showed hyperemic and edematous brain tissue with some degenerated neurons 14-15 . With such findings, Avula et al suggested the possibility of hypercoagulation leading to macro and micro thrombi formation in the vessels during the COVID-19 infection 16 .…”

Section: Discussionmentioning

confidence: 99%

How closely is COVID-19 related to HCoV, SARS, and MERS? : Clinical comparison of coronavirus infections and identification of risk factors influencing the COVID-19 severity using common data model (CDM)

Kim

et al. 2020

Preprint

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South Korea was one of the epicenters for both the 2015 Middle East Respiratory Syndrome (MERS) and 2019 COVID-19 outbreaks. However, there has been a lack of published literature, especially using the EMR records, that provides a comparative summary of the prognostic factors present in the coronavirus-derived diseases. Therefore, in this study, we aimed to compare and evaluate the distinct clinical traits between the infected patients of different coronaviruses, including the lesser pathogenic HCoV strains, SARS-CoV, MERS-CoV, and SARS-CoV-2. We aimed to observe the extent of resemblance within the clinical features between the different coronavirus disease groups and to identify unique factors by disease severity that may influence the prognosis of COVID-19 patients. Here, we utilize the common data model (CDM), which is the database that houses EMR records transformed into the common format to be used by multiple institutions. For the comparative analyses between the different disease groups as well as the mild and non-mild COVID-19 patients, we used independent t-test, Scheffe post-hoc test, and Games-howell post-hoc test for continuous variables, and chi-square test and Fisher’s exact test for categorical variables. From the analyses, we selected variables that showed p-values less than 0.05 to predict COVID-19 severity by a nominal logistic regression with adjustments to age and gender. The results showed diabetes, cardiovascular and cerebrovascular diseases, cancer, pulmonary disease, gastrointestinal disease, and renal disease in all patient groups. The proportions of cancer patients were the highest compared to other comorbidities in every comparative analysis, with no statistical significance. Additionally, we observed high degree of clinical similarity between COVID-19 and SARS patients within more than 50% of the selected clinical variables in the analyses, with no statistical significance between the two groups. Our research effectively utilized the integrated CDM to reflect real-world health challenges in the context of coronavirus. We expect the results from our study to provide clinical insights that can serve as predictor of risk factors for the future coronavirus-derived outbreak as well as the prospective guidelines for the clinical treatments.

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“…Severe cerebrovascular events were more common among older COVID-19 patients with severe respiratory complications caused by SARS-CoV-2 infection [ 47 ]. However, the striking fact is that there is a case of large-vessel strokes in COVID-19 patients younger than 50 years old, that is people not in the stroke risk group [ 48 ].…”

Section: Neuroinflammation and Cytokine Storm In Sars-cov-2 Infectmentioning

confidence: 99%

The Impact of SARS-CoV-2 Infection on the Development of Neurodegeneration in Multiple Sclerosis

Dziedzic

Saluk‐Bijak

Miller

et al. 2021

IJMS

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The novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global challenge. Currently, there is some information on the consequences of COVID-19 infection in multiple sclerosis (MS) patients, as it is a newly discovered coronavirus, but its far-reaching effects on participation in neurodegenerative diseases seem to be significant. Recent cases reports showed that SARS-CoV-2 may be responsible for initiating the demyelination process in people who previously had no symptoms associated with any nervous system disorders. It is presently known that infection of SARS-CoV-2 evokes cytokine storm syndrome, which may be one of the factors leading to the acute cerebrovascular disease. One of the substantial problems is the coexistence of cerebrovascular disease and MS in an individual’s life span. Epidemiological studies showed an enhanced risk of death rate from vascular disabilities in MS patients of approximately 30%. It has been demonstrated that patients with severe SARS-CoV-2 infection usually show increased levels of D-dimer, fibrinogen, C-reactive protein (CRP), and overactivation of blood platelets, which are essential elements of prothrombotic events. In this review, the latest knowledge gathered during an ongoing pandemic of SARS-CoV-2 infection on the neurodegeneration processes in MS is discussed.

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Cerebrovascular disease in COVID-19: Is there a higher risk of stroke?

Cited by 28 publications

References 34 publications

Stroke in COVID-19: A systematic review and meta-analysis

Stroke in COVID-19: A systematic review and meta-analysis

How closely is COVID-19 related to HCoV, SARS, and MERS? : Clinical comparison of coronavirus infections and identification of risk factors influencing the COVID-19 severity using common data model (CDM)

The Impact of SARS-CoV-2 Infection on the Development of Neurodegeneration in Multiple Sclerosis

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