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Journal of Neurology

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01-01-2021 | Coronavirus | Original Communication

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

Authors: Urvish Patel, Preeti Malik, Dhaivat Shah, Achint Patel, Mandip Dhamoon, Vishal Jani

Published in: Journal of Neurology | Issue 1/2021

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 associated with ICU admission [r: 0.60; OR: 1.82 (1.25–2.69)], mechanical ventilation [r: 0.29; OR: 1.33 (1.09–1.63)], and mortality [r: 0.35; OR: 1.42 (1.14–1.77)] amongst COVID-19 hospitalizations. 9/11 studies reported data on binary composite outcomes, the pooled prevalence of pre-existing CeVD was 4.3% (155/3603) and 7.46% (83/1113) amongst COVID-19 hospitalizations and COVID-19 hospitalization-related poor outcomes, respectively. In meta-analysis, COVID-19 patient with pre-existing CeVD had 2.67-fold (1.75–4.06) higher odds of poor outcomes.

Conclusion

COVID-19 patients with pre-existing cerebrovascular disease have poor outcomes and extra precautions should be taken in managing such patients during the ongoing pandemic.

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Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B (2020) Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. https://doi.org/10.1001/jamaneurol.2020.1127CrossRefPubMedPubMedCentral

Li Y-C, Bai W-Z, Hashikawa T (2020) The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 92(6):552–555. https://doi.org/10.1002/jmv.25728CrossRefPubMed

Baig AM, Khaleeq A, Ali U, Syeda H (2020) Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci 11(7):995–998. https://doi.org/10.1021/acschemneuro.0c00122CrossRefPubMed

Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012. https://doi.org/10.1001/jama.283.15.2008CrossRefPubMed

GA Wells, B Shea, D O'Connell, J Peterson, V Welch, M Losos, P Tugwell (2020) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Professor GA Wells, Department of Epidemiology and Community Medicine. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (2019) Cochrane handbook for systematic reviews of interventions, 2nd edn. John Wiley & Sons, ChichesterCrossRef

Aggarwal G, Lippi G, Michael Henry B (2020) Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): a pooled analysis of published literature. Int J Stroke. https://doi.org/10.1177/1747493020921664CrossRefPubMed

Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW (2020) heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 141(9):e139–e596. https://doi.org/10.1161/cir.0000000000000757CrossRefPubMed

Chen CY, Lee CH, Liu CY, Wang JH, Wang LM, Perng RP (2005) Clinical features and outcomes of severe acute respiratory syndrome and predictive factors for acute respiratory distress syndrome. J Chin Med Assoc JCMA 68(1):4–10. https://doi.org/10.1016/s1726-4901(09)70124-8CrossRefPubMed

10.

Lee SY, Khang YH, Lim HK (2019) Impact of the 2015 middle east respiratory syndrome outbreak on emergency care utilization and mortality in South Korea. Yonsei Med J 60(8):796–803. https://doi.org/10.3349/ymj.2019.60.8.796CrossRefPubMedPubMedCentral

11.

Steardo L, Steardo L Jr, Zorec R, Verkhratsky A (2020) Neuroinfection may contribute to pathophysiology and clinical manifestations of COVID-19. Acta Physiol. https://doi.org/10.1111/apha.13473CrossRef

12.

Grau AJ, Buggle F, Becher H, Zimmermann E, Spiel M, Fent T, Maiwald M, Werle E, Zorn M, Hengel H, Hacke W (1998) Recent bacterial and viral infection is a risk factor for cerebrovascular ischemia: clinical and biochemical studies. Neurology 50(1):196–203. https://doi.org/10.1212/wnl.50.1.196CrossRefPubMed

13.

Barton LM, Duval EJ, Stroberg E, Ghosh S, Mukhopadhyay S (2020) COVID-19 autopsies, Oklahoma, USA. Am J Clin Pathol 153(6):725–733CrossRefPubMed

14.

Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ, Vander Heide RS (2020) Pulmonary and cardiac pathology in Covid-19: the first autopsy series from New Orleans. medRxiv. https://doi.org/10.1101/2020.04.06.20050575CrossRefPubMedPubMedCentral

15.

Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, Liu C, Yang C (2020) Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. https://doi.org/10.1016/j.bbi.2020.03.031CrossRefPubMedPubMedCentral

16.

Kansagra AP, Goyal MS, Hamilton S, Albers GW (2020) Collateral effect of Covid-19 on stroke evaluation in the United States. N Engl J Med. https://doi.org/10.1056/NEJMc2014816CrossRefPubMedPubMedCentral

17.

Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, Zhang C, Boyle C, Smith M, Phillips JP (2020) Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med. https://doi.org/10.1056/NEJMsb2005114CrossRefPubMed

18.

Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, Liu L, Shan H, Lei C-l, Hui DSC, Du B, Li L-j, Zeng G, Yuen K-Y, Chen R-c, Tang C-l, Wang T, Chen P-y, Xiang J, Li S-y, Wang J-l, Liang Z-j, Peng Y-x, Wei L, Liu Y, Hu Y-h, Peng P, Wang J-m, Liu J-y, Chen Z, Li G, Zheng Z-j, Qiu S-q, Luo J, Ye C-j, Zhu S-y, Zhong N-s (2020) Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. https://doi.org/10.1056/NEJMoa2002032CrossRefPubMedPubMedCentral

19.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323(11):1061–1069. https://doi.org/10.1001/jama.2020.1585CrossRefPubMedPubMedCentral

20.

Xu X-W, Wu X-X, Jiang X-G, Xu K-J, Ying L-J, Ma C-L, Li S-B, Wang H-Y, Zhang S, Gao H-N, Sheng J-F, Cai H-L, Qiu Y-Q, Li L-J (2020) Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 368:m606. https://doi.org/10.1136/bmj.m606CrossRefPubMedPubMedCentral

21.

Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA, Gao YD (2020) Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. https://doi.org/10.1111/all.14238CrossRefPubMed

22.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y (2020) Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. https://doi.org/10.1016/s2213-2600(20)30079-5CrossRefPubMedPubMedCentral

23.

Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, Xiong Y, Cheng Z, Gao S, Liang K, Luo M, Chen T, Song S, Ma Z, Chen X, Zheng R, Cao Q, Wang F, Zhang Y (2020) Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa270CrossRef

24.

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, Huang H, Zhang L, Zhou X, Du C, Zhang Y, Song J, Wang S, Chao Y, Yang Z, Xu J, Zhou X, Chen D, Xiong W, Xu L, Zhou F, Jiang J, Bai C, Zheng J, Song Y (2020) Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2020.0994CrossRefPubMedPubMedCentral

25.

Wang L, He W, Yu X, Hu D, Bao M, Liu H, Zhou J, Jiang H (2020) Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. https://doi.org/10.1016/j.jinf.2020.03.019CrossRefPubMedPubMedCentral

26.

Ruan Q, Yang K, Wang W, Jiang L, Song J (2020) Correction to: clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. https://doi.org/10.1007/s00134-020-06028-zCrossRefPubMedPubMedCentral

27.

Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W, Tian DS (2020) Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa248CrossRefPubMedPubMedCentral

28.

Paranjpe I, Russak A, De Freitas JK, Lala A, Miotto R, Vaid A, Johnson KW, Danieletto M, Golden E, Meyer D, Singh M, Somani S, Manna S, Nangia U, Kapoor A, O'Hagan R, O'Reilly PF, Huckins LM, Glowe P, Kia A, Timsina P, Freeman RM, Levin MA, Jhang J, Firpo A, Kovatch P, Finkelstein J, Aberg JA, Bagiella E, Horowitz CR, Murphy B, Fayad ZA, Narula J, Nestler EJ, Fuster V, Cordon-Cardo C, Charney DS, Reich DL, Just AC, Bottinger EP, Charney AW, Glicksberg BS, Nadkarni G (2020) Clinical characteristics of hospitalized covid-19 patients in New York City. Nature. https://doi.org/10.1101/2020.04.19.20062117CrossRef

Title: Pre-existing cerebrovascular disease and poor outcomes of COVID-19 hospitalized patients: a meta-analysis
Authors: Urvish Patel
Preeti Malik
Dhaivat Shah
Achint Patel
Mandip Dhamoon
Vishal Jani
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Coronavirus
Stroke
SARS-CoV-2
COVID-19
Published in: Journal of Neurology / Issue 1/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-020-10141-w

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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