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Advanced Neurologyurology
Advanced Ne AIS in patients with COVID-19

levels and increased D-dimer levels, which implies that thrombosis and/or thromboembolism might be the underlying
mechanism. These patients tend to have worse prognosis regardless of whether they receive reperfusion treatment.

Keywords: Acute ischemic stroke; COVID-19; Clinical characteristics and outcomes

1. Introduction 2.2. Inclusion and exclusion criteria
The outbreak of coronavirus disease 2019 (COVID-19), Two investigators independently screened the identified
caused by severe acute respiratory syndrome coronavirus articles and selected studies using pre-specified criteria, with
2 (SARS-CoV-2), has rapidly spread worldwide since disagreements resolved through consensus. Studies were
December 2019, with more than 258 million confirmed deemed eligible if they (1) were observational studies with
cases and 5.17 million deaths as of November 24, information on clinical features and outcomes of new-onset
2021 . Even though the infection mainly results in ischemic stroke in patients with COVID-19; (2) included at
[1]
respiratory symptoms, an increasing number of cases in least 20 patients with AIS over 18 years of age; (3) SARS-
cerebrovascular disease, particularly acute ischemic stroke CoV-2 infection was confirmed with a positive polymerase
(AIS), have been confirmed . The incidence of AIS varied chain reaction test or International Classification of Diseases,
[2]
[10]
from 1% to 3%, and reached up to 6% in seriously ill Tenth Revision (ICD-10) codes ; and (4) the diagnosis of
patients [3,4] .Emerging data suggest that stroke in the context stroke was based on neuroimaging and clinical symptoms.
of COVID-19 may be associated with increased mortality We excluded comments, editorials, letters, reviews, case
and disability and presents with unique manifestations [5,6] . reports, small case series (<20 cases), animal studies, and
Although most of these studies have limited sample sizes duplicate publications involving the same patient cohorts.
or are restricted to particular geographic regions, thus
showing considerable heterogeneity among studies, these 2.3. Data extraction
individual studies provide valuable data on patients with Data extraction was conducted independently by two
AIS who have COVID-19. Therefore, the meta-analysis investigators using a pre-designed form. For each eligible article,
that can break the regional limitations and collect outcomes we extracted the first author, publication year, study design,
and characteristics of patients with COVID-19 in the real geographic region, recruitment period, clinical definition of
world can provide new insights. COVID-19 used in the study, sample size, age, gender, clinical
The previous meta-analyses have mainly focused manifestations, laboratory findings, neuroimaging findings,
on stroke risk factors and outcomes [7,8] . With emerging and short-term (in hospital or on discharge) outcomes of AIS.
evidence, we performed an updated systemic review and Stroke etiology was classified according to the Trial
meta-analysis to illustrate the specific clinical features, of ORG 10172 in Acute Stroke Treatment (TOAST)
laboratory findings, neuroimaging, revascularization criteria . Stroke severity was measured using National
[11]
treatment, as well as short-term outcomes of patients Institutes of Health Stroke Scale (NIHSS). Functional
with COVID-19 who have AIS, to assist with better independence (i.e., favorable functional outcome) was
identification and management of these patients. defined as modified Rankin scale score 0-2.
2. Methods 2.4. Quality appraisal
This study was conducted following the Preferred We used the Newcastle-Ottawa Scale (NOS) to assess the
[12]
Reporting Items for Systematic Reviews and Meta- methodologic quality of the selected studies .Specifically, the
Analyses guidelines . NOS scale evaluates quality in three aspects, including selection
[9]
of study groups, comparability of the study groups, and
2.1. Search strategy assessment of exposure or outcome of interest. A total of seven
We conducted a systematic search of PubMed, Embase, out of nine points is considered a low risk of bias, a score of 4 – 6
and Web of Science databases from their inception points a moderate risk, and a score <4 points a high risk of bias.
to November 29, 2021, with no language restrictions.
The search algorithm was modified by an information 2.5. Statistical analysis
specialist; details are available in Table S1. References cited Because most included studies only reported raw data, we
in retrieved articles as well as any review articles were also used unadjusted estimates for meta-analysis. To obtain
reviewed to identify additional studies. a more conservative estimate of effect size, zero-events

Volume 1 Issue 1 (2022) 2 https://doi.org/10.36922/an.v1i1.28