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Advanced Neurology AIS in patients with COVID-19

Table 2. (Continued).
Variables No. of AIS patients AIS patients OR (95% CI) OR (95% CI) P I 2 heterogeeneity % P heterogeeneity
studies with without or pooled MD or pooled MD
COVID-19 COVID-19 Random effects Fixed effects
Outcomes following IVT
HT 2 28/117 75/543 1.96 (1.20, 3.19) 2.33 (0.96, 5.6) 0.007* 51 0.15
sICH 3 11/139 41/591 1.34 (0.60, 2.99) 1.25 (0.63, 2.48) 0.52 8 0.34
In-hospital 2 31/123 52/492 2.84 (1.72,4.68) 2.82 (1.71, 4.66) < 0.0001*** 0 0.6
mortality
Favorable 2 32/123 203/492 0.52 (0.33, 0.81) 0.52 (0.33, 0.81) 0.004* 0 0.75
discharge
Outcomes following MT
HT 1 - - - - - - -
sICH 4 4/51 38/654 2.04 (0.71, 5.86) 1.92 (0.66, 5.57) 0.18 0 0.76
In-hospital 4 46/137 460/3552 3.22 (2.16, 4.79) 3.27 (2.24, 4.78) < 0.00001*** 1 0.39
mortality
Favorable 2 51/117 1987/3506 0.56 (0.38, 0.82) 0.56 (0.38, 0.81) 0.003* 0 0.79
discharge
AIS, acute ischemic stroke; APTT, activated partial thromboplastin time; ASPECTS, Alberta Stroke Program Early CT Score; CI, confidence intervals;
COVID-19, coronavirus disease 2019; CRP, C-reactive protein; HT, hemorrhagic transformation; ICA, internal carotid artery; IVT, intravenous
thrombolysis; MCA, middle cerebral artery; MD, mean difference; MT, mechanical thrombectomy; NIHSS, National Institutes of Health Stroke
Scale; OR, odd ratio; PLT, platelets; PT, prothrombin time; sICH, symptomatic intracerebral hemorrhage; TOAST, Trial of Org 10172 in Acute Stroke
Treatment; WBC, white blood cell count. *P<0.05, ** P<0.005,*** P<0.001. items were calculated with weighted MD. items were calculated with
b
a
standard MD.
3. Results 3.2. Study quality and publication bias
Literature searches of the three databases yielded a total The methodological quality of each included study after
of 7961 potentially relevant references. After removing critical appraisal using the NOS is summarized in Table S2.
duplicates and screening titles and abstract, 772 full-text Most included studies were assessed as low risk of bias
articles were retrieved. Of these, 732 were removed as no (n = 31, 81.6%) whereas the remaining studies were
data of interest were provided. Finally, 38 observational assessed as moderate risk of bias (n = 7, 18.4%). There
studies involving 76,894 individuals met the eligibility was no evidence of publication bias in the meta-analyses
criteria and were included in the meta-analysis. The (Figures 2 and 3).
detailed process of study identification and selection is 3.3. Clinical features
presented in Figure 1.
3.3.1. Etiology of AIS in patients with COVID-19
3.1. Study characteristics
Regarding the etiology of stroke in patients with
The characteristics of the included studies are summarized COVID-19 according to the TOAST criteria,
in Table 1. Of these, 32 were cohort studies [5,6,16-45] , two cryptogenic stroke was the most common type (41.0%,
were case–control studies [46,47] , and four were cross- 95% CI: 33.9 – 48.0%; I : 76.1%; 17 studies), followed by
2
sectional studies [48-51] . Patients number varied from 29 to cardioembolism (26.4%, 95% CI: 20.5 – 32.4%; I : 76.3%;
2
41,971. The most common geographic regions were North 18 studies), large vessel atherosclerosis (13.9%, 95%
America (n = 19, 50%) and Europe (n = 19, 50%). Among CI: 9.7 – 18.1%; I : 72.9%; 18 studies), and small vessel
2
these studies, there were several multiple geographic stroke (7.6%, 95% CI: 4.8 – 10.3%; I : 64.5%; 19 studies)
2
regions and only one study was conducted in Oceania (Table 2).
and Africa. About clinical design, three studies compared
COVID-19 patients with and without AIS; 30 studies In comparison to patients who did not have COVID-
compared AIS patients with COVID-19 versus those 19, those with COVID-19 were more likely to develop
2
without COVID-19. The remaining five studies merely cryptogenic stroke (OR: 1.83, 95% CI: 1.24 – 2.70; I : 62%;
depict the characteristics and outcomes of AIS patients 11 studies); no differences were observed for other stroke
with COVID-19. subtypes (Table 3).

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