Pre-existing cerebrovascular disease and poor outcomes of COVID-19 hospitalized patients: a meta-analysis

Abstract

Background Due to pro-inflammatory and hypercoagulation states, COVID-19 infection is believed to increase the risk of stroke and worsen the outcomes of the patients having pre-existing cerebrovascular diseases (CeVD). There is limited literature on prevalence of pre-existing CeVD in COVID-19 patients, and outcomes are unknown. The objective of this meta-analysis is to evaluate the outcomes of COVID-19 patients with pre-existing CeVD. Methods English full-text-observational studies having data on epidemiological characteristics of COVID-19 patients were identified searching PubMed, Web of Science, and Scopus using MeSH-terms COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV from December 1, 2019 to April 30, 2020. Studies having CeVD or stroke as one of the pre-existing comorbidities and described outcomes including intensive care unit (ICU) admission, mechanical ventilation utilization, and mortality were selected with consensus of three reviewers. Following MOOSE protocol, 11 studies were included. The pooled prevalence of CeVD and outcomes were calculated. Meta-regression was performed, and correlation coefficient (r) and odds ratio (OR) were estimated to evaluate the effects of pre-existing CeVD on outcomes of COVID-19 patients. Meta-analysis with random-effects model was used to calculate OR along with its 95% CI from the studies containing data on composite poor outcome. Results Out of 8/11 studies showing data on mortality and mechanical ventilation, and 7/11 on ICU admission, pooled prevalence of pre-existing CeVD was 4.4% (244/4987). In age-adjusted meta-regression analysis, pre-existing CeVD was

Interrelations between COVID-19 and other disorders

“…This result has been based on considering 852 patients (603 survivors and 249 non-survivors) with confirmed SARS-CoV-2 infection from four retrospective Chinese studies. Several meta-analyses confirmed such association [ [139] , [140] , [141] ]. Particular precautions should be taken in the management of COVID-19 patients with preexisting cerebrovascular disease.…”

Risk factors of developing critical conditions in Iranian patients with COVID-19

“…Literature has revealed that novel coronavirus in patients with pre-existing neurological diseases is associated with poor outcomes [ 39 , 40 ]. A study in Spain indicated that chronic neurologic disease is among the most relevant comorbidities of COVID-19 [ 37 ].…”

Psychological and neuropsychiatric implications of COVID-19

“…This results in highly increased D-dimer fibrin, which is now considered to be a risk factor of disease severity and mortality [73]. Indeed, COVID 19 patients with a previous history of cerebrovascular disease have higher risk of severe COVID-19 than those without (RR 2.07] [74]) and 2.67 higher odds for poor outcome, including the need for intensive care admission and mechanical ventilation, as well as higher rate of mortality [75].…”