Association between SARS-CoV-2 and stroke: perspectives from a metaumbrella-review

In the face of the global COVID-19 pandemic, the need arose to investigate potential complications associated with SARS-CoV-2, including the risk of stroke.

Objective

This study aimed to verify the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the risk of stroke on the basis of systematic reviews and meta-analyses to assess the inclusion of the virus as a new risk factor for cerebrovascular diseases.

Methods

A metaumbrella study was conducted, which included 34 systematic reviews, of which 4 were selected for the final analysis on the basis of methodological quality and consistency. The analysis aggregated the results of 70 primary studies, considering different stroke subtypes and outcomes associated with COVID-19. Study heterogeneity was assessed via the I² index, and significance bias was verified via Egger’s test.

Results

COVID-19 severity was significantly associated with an increased risk of stroke (eOR = 2.48; 95% CI: 1.55–3.95), particularly ischemic stroke (eOR = 1.76; 95% CI: 1.11–2.80) and hemorrhagic stroke (eOR = 3.86; 95% CI: 1.79–8.33). Additionally, patients with cerebrovascular comorbidities had higher mortality (eOR = 2.48; 95% CI: 2.48–19.63), as did those who had previously suffered a stroke (eOR = 6.08; 95% CI: 3.73–9.91).

Conclusion

The association between SARS-CoV-2 and stroke incidence was consistent and significant, suggesting that COVID-19 should be considered a new risk factor for cerebrovascular diseases. However, the high heterogeneity among the studies analyzed reinforces the need for further research to consolidate this relationship.