Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study

doi:10.1016/j.ebiom.2020.102939

eBioMedicine

Volume 59, September 2020, 102939

https://doi.org/10.1016/j.ebiom.2020.102939 Get rights and content

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Abstract

Background

There is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients.

Methods

This multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines.

Findings

We received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke—123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1–3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4–4.7, p = 0.006) were predictive of stroke.

Interpretation

The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients.

Funding

None.

Keywords

Cerebrovascular disorders

Stroke

SARS-CoV-2

COVID-19

Venous thrombosis

Intracranial haemorrhage

Neurological complications

Cited by (0)

: Collaborators - The Multinational COVID-19 Stroke Study Group:

Prof Mohammad Hossein Harirchian, MD,¹ Nazanin Ahmadzadeh, MD,² Thomas Yasuda, MD,³ Fabricio Cardoso, MD,³ Asadollah Mirghasemi, MD,⁴ Alireza Janbakhsh, MD,⁵ Mohammad Hossein Zamanian, MD, ⁵ Zeinab Mohseni Afshar, MD,⁵ Ali H. Kassem, MD,⁶ Haidar H. Hoummani, MD,⁶ Arefeh Babazadeh, MD,⁷ Soheil Ebrahimpour, MD, ⁷ Sima Mohseni, MD, MPH,⁷ Firas Kobeissy, PhD^8,9 Navneet Singh Dang, MD,¹⁰ B. V. Ganesh, MBBS,¹¹ Radha Krishna Ramesh, MD,¹² Sedighe Basirjafari, MD,¹³ Janardhanan Saravanan, Pharm Ph. D,¹⁴ Faissal Qak, MD,¹⁵ Prof Afshin Borhani-Haghighi.¹⁶

¹Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran;

²Istanbul Bilim University, Istanbul, Turkey;

³Neurology Department, Centro Médico de Campinas, São Paulo, Brazil;

⁴Department of Anesthesiology, University of Ottawa, Canada;

⁵Infection Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran;

⁶Lebanese University/Beirut Governmental University Hospital, Beirut, Lebanon;

⁷Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.

⁸Program of Neurotrauma, Neuroproteomics and Biomarker Research (NNBR), University of Florida, Florida, USA;

⁹Lebanese Ministry of Health, Beirut, Lebanon;

¹⁰Department of Medicine, Geisinger Health System, Pennsylvania, USA;

¹¹ESIC Hospital, Karnataka, India;

¹²C.V. Raman General Hospital, Karnataka, India;

¹³Department of Radiology, Hashemi Rafsanjani Hospital, Khorasan, Iran;

¹⁴PES University, Bengaluru, Karnataka, India;

¹⁵Department of Anesthesiology, University of Ottawa, Canada;

¹⁶Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.