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Advanced Neurology

REVIEW ARTICLE
Clinical characteristics and outcomes of

acute ischemic stroke in patients with
COVID-19: A systematic review and

meta-analysis of global data

Zhelv Yao 1,2,3,4 , Lili Huang 1,2,3,4 , Yue Cheng 1,2,3,4 , Ruowen Qi , Biyun Xu ,
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Qingxiu Zhang 1,2,3,4 *, and Liqun Zhang *
1 Department of Neurology of Drum Tower Hospital, Medical School and the State Key Laboratory of
Pharmaceutical Biotechnology, Nanjing University, Nanjing 210008, China
2 Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School,
Nanjing, Jiangsu, China
3 Nanjing Neurology Clinic Medical Center, Nanjing 210008, China
4 Institute of Brain Science, Nanjing University, Nanjing 210008, China
5 Medical Statistics and Analysis Center, Nanjing Drum Tower Hospital, Nanjing University Medical
School, 321 Zhongshan Road, Nanjing, 210008, China
6 St George’s University Hospital NHS Foundation Trust, London, Blackshaw Rd, London SW17 0QT,
United Kingdom

Abstract

Objective. There is increased concern regarding acute ischemic stroke (AIS) in
*Corresponding authors:
Qingxiu Zhang patients with coronavirus disease 2019 (COVID-19). The aim of this study was to
(zhangqingxiu@163.com) depict the manifestations and outcomes of COVID-19-associated AIS.
Liqun Zhang Methods. We systematically searched for eligible studies describing AIS in patients
(liqun.zhang@stgeorges.nhs.uk) with COVID-19 using PubMed, Embase, and Web of Science up to November 29,
Citation: Yao Z, Huang L, 2021. We complied with the Preferred Reporting Items for Systematic Reviews and
Cheng Y, et al. 2022, Clinical Meta-Analyses guidelines and used the Newcastle–Ottawa Scale to assess data
characteristics and outcomes of
acute ischemic stroke in patients quality. The data were pooled using fixed- and random-effects models.
with COVID-19: A systematic review Results. Thirty-eight eligible studies involving 76,894 participants were included in
and meta-analysis of global data. this meta-analysis. Compared with AIS patients who did not have COVID-19, patients
Adv Neuro, 1(1): 28.
https://doi.org/10.36922/an.v1i1.28 with COVID-19 were more likely to have anterior circulation stroke (odds ratio [OR]:
2.29, 95% confidence interval [CI]: 1.03 – 5.10; I : 37%), particularly involving the
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Received: December 8, 2021
internal carotid artery (OR: 1.85, 95% CI: 1.19 – 2.88; I : 0); more severe neurological
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Accepted: March 2, 2022 deficit (National Institutes of Health Stroke Scale [NIHSS]) (weighted mean difference
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Published Online: March 24, 2022 [WMD]: 3.21, 95% CI: 2.13 – 4.29; I : 64%); higher proportion of cryptogenic stroke (OR:
1.83, 95% CI: 1.24 – 2.70; I : 62%), large vessel occlusion (OR: 1.68, 95% CI: 1.10 – 2.57;
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Copyright: © 2022 Author(s).
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This is an Open Access article I : 75%), and multi-territory involvement (OR: 2.64, 95% CI: 1.62 – 4.29; I : 0%); higher
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distributed under the terms of the C-reactive protein levels (WMD: 55.90, 95% CI: 33.32 – 78.49; I : 67%), and D-dimer
Creative Commons Attribution levels (standardized mean difference: 0.81, 95% CI: 0.52 – 1.10; I : 59%). The proportion
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License, permitting distribution,
and reproduction in any medium, of poor outcomes were higher among patients with COVID-19, including increased
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provided the original work is risk of in-hospital death (OR: 3.70, 95% CI: 2.73 – 5.02; I : 64%) and lower possibility
properly cited. of favorable discharge (OR: 0.49, 95% CI: 0.39 – 0.61; I : 0). However, COVID-19 did not
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Publisher’s Note: AccScience increase the risk of hemorrhagic transformation (OR: 1.34, 95% CI: 0.91 – 1.98; I : 39%)
Publishing remains neutral with and symptomatic intracerebral hemorrhage (OR: 1.46, 95% CI: 0.81 – 2.62; I : 0).
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regard to jurisdictional claims in
published maps and institutional Conclusion. AIS patients with COVID-19 seem to display a pattern of large vessel
affiliations. occlusion and multi-territory infarcts. These patients have high inflammatory marker
Volume 1 Issue 1 (2022) 1 https://doi.org/10.36922/an.v1i1.28