Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis
Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthe...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
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Frontiers Research Foundation
2020
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| Online Access: | http://psasir.upm.edu.my/id/eprint/85939/ |
| _version_ | 1848860217348980736 |
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| author | Lee, Kai Wei Yusof Khan, Abdul Hanif Khan Ching, Siew Mooi Chia, Peck Kee Loh, Wei Chao Abdul Rashid, Anna Misya'il Baharin, Janudin Inche Mat, Liyana Najwa Wan Sulaiman, Wan Aliaa Devaraj, Navin Kumar Sivaratnam, Dhashani Basri, Hamidon Hoo, Fan Kee |
| author_facet | Lee, Kai Wei Yusof Khan, Abdul Hanif Khan Ching, Siew Mooi Chia, Peck Kee Loh, Wei Chao Abdul Rashid, Anna Misya'il Baharin, Janudin Inche Mat, Liyana Najwa Wan Sulaiman, Wan Aliaa Devaraj, Navin Kumar Sivaratnam, Dhashani Basri, Hamidon Hoo, Fan Kee |
| author_sort | Lee, Kai Wei |
| building | UPM Institutional Repository |
| collection | Online Access |
| description | Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthesis of the available data has not been conducted. Therefore, we performed a systematic review and meta-analysis of currently available epidemiological, clinical, and laboratory data related to both stroke and COVID-19 infection. Methods: We systematically searched Medline, Cinahl, and PubMed for studies related to stroke and COVID-19 from inception up to June 4, 2020. We selected cohort studies, case series, and case reports that reported the occurrence of stroke in COVID-19 patients. A fixed-effects model was used to estimate the pooled frequency of stroke in COVID-19 patients with a 95% confidence interval (CI). Results: Twenty-eight studies were included in the systematic review and seven studies for the meta-analysis. The pooled frequency of stroke in COVID-19 patients was 1.1% (95% CI: 0.8, 1.3). The heterogeneity was low (I 2 = 0.0%). Even though the frequency of stroke among patients having COVID-19 infection was low, those with concomitant COVID-19 infection and stroke suffered from a more severe infection and eventually had a poorer prognosis with a higher mortality rate (46.7%) than COVID-19 alone. Many COVID-19 patients shared the common traditional risk factors for stroke. We noted that ischemic stroke involving the anterior circulation with large vessels occlusion is the most common type of stroke with more strokes seen in multi-territorial regions, suggesting systemic thromboembolism. An elevated level of D-dimers, C-reactive protein, ferritin, lactic acid dehydrogenase, troponin, ESR, fibrinogen, and a positive antiphospholipid antibody were also noted in this review. Conclusions: The occurrence of stroke in patients with COVID-19 infection is uncommon, but it may pose as an important prognostic marker and indicator of severity of infection, by causing large vessels occlusion and exhibiting a thrombo-inflammatory vascular picture. Physicians should be made aware and remain vigilant on the possible two-way relationship between stroke and COVID-19 infection. The rate of stroke among patients with COVID-19 infection may increase in the future as they share the common risk factors. |
| first_indexed | 2025-11-15T12:41:43Z |
| format | Article |
| id | upm-85939 |
| institution | Universiti Putra Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-15T12:41:43Z |
| publishDate | 2020 |
| publisher | Frontiers Research Foundation |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | upm-859392023-10-31T03:23:59Z http://psasir.upm.edu.my/id/eprint/85939/ Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis Lee, Kai Wei Yusof Khan, Abdul Hanif Khan Ching, Siew Mooi Chia, Peck Kee Loh, Wei Chao Abdul Rashid, Anna Misya'il Baharin, Janudin Inche Mat, Liyana Najwa Wan Sulaiman, Wan Aliaa Devaraj, Navin Kumar Sivaratnam, Dhashani Basri, Hamidon Hoo, Fan Kee Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthesis of the available data has not been conducted. Therefore, we performed a systematic review and meta-analysis of currently available epidemiological, clinical, and laboratory data related to both stroke and COVID-19 infection. Methods: We systematically searched Medline, Cinahl, and PubMed for studies related to stroke and COVID-19 from inception up to June 4, 2020. We selected cohort studies, case series, and case reports that reported the occurrence of stroke in COVID-19 patients. A fixed-effects model was used to estimate the pooled frequency of stroke in COVID-19 patients with a 95% confidence interval (CI). Results: Twenty-eight studies were included in the systematic review and seven studies for the meta-analysis. The pooled frequency of stroke in COVID-19 patients was 1.1% (95% CI: 0.8, 1.3). The heterogeneity was low (I 2 = 0.0%). Even though the frequency of stroke among patients having COVID-19 infection was low, those with concomitant COVID-19 infection and stroke suffered from a more severe infection and eventually had a poorer prognosis with a higher mortality rate (46.7%) than COVID-19 alone. Many COVID-19 patients shared the common traditional risk factors for stroke. We noted that ischemic stroke involving the anterior circulation with large vessels occlusion is the most common type of stroke with more strokes seen in multi-territorial regions, suggesting systemic thromboembolism. An elevated level of D-dimers, C-reactive protein, ferritin, lactic acid dehydrogenase, troponin, ESR, fibrinogen, and a positive antiphospholipid antibody were also noted in this review. Conclusions: The occurrence of stroke in patients with COVID-19 infection is uncommon, but it may pose as an important prognostic marker and indicator of severity of infection, by causing large vessels occlusion and exhibiting a thrombo-inflammatory vascular picture. Physicians should be made aware and remain vigilant on the possible two-way relationship between stroke and COVID-19 infection. The rate of stroke among patients with COVID-19 infection may increase in the future as they share the common risk factors. Frontiers Research Foundation 2020 Article PeerReviewed Lee, Kai Wei and Yusof Khan, Abdul Hanif Khan and Ching, Siew Mooi and Chia, Peck Kee and Loh, Wei Chao and Abdul Rashid, Anna Misya'il and Baharin, Janudin and Inche Mat, Liyana Najwa and Wan Sulaiman, Wan Aliaa and Devaraj, Navin Kumar and Sivaratnam, Dhashani and Basri, Hamidon and Hoo, Fan Kee (2020) Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis. Frontiers in Neurology, 11. pp. 1-20. ISSN 1664-2295 https://www.frontiersin.org/articles/10.3389/fneur.2020.579070/full 10.3389/fneur.2020.579070 |
| spellingShingle | Lee, Kai Wei Yusof Khan, Abdul Hanif Khan Ching, Siew Mooi Chia, Peck Kee Loh, Wei Chao Abdul Rashid, Anna Misya'il Baharin, Janudin Inche Mat, Liyana Najwa Wan Sulaiman, Wan Aliaa Devaraj, Navin Kumar Sivaratnam, Dhashani Basri, Hamidon Hoo, Fan Kee Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis |
| title | Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis |
| title_full | Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis |
| title_fullStr | Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis |
| title_full_unstemmed | Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis |
| title_short | Stroke and novel coronavirus infection in humans: a systematic review and meta-analysis |
| title_sort | stroke and novel coronavirus infection in humans: a systematic review and meta-analysis |
| url | http://psasir.upm.edu.my/id/eprint/85939/ http://psasir.upm.edu.my/id/eprint/85939/ http://psasir.upm.edu.my/id/eprint/85939/ |