The overall stroke risk in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is 0.5%. Independent predictors of stroke among this population are mechanical ventilation and history of ischemic heart disease, according to data from a multinational meta-analysis published in EBioMedicine.

The meta-analysis included 17,799 hospitalized patients from 99 tertiary centers from 11 countries. Of the 156 patients (0.9%) who had a stroke, 123 patients (79%) presented with an ischemic stroke, 27 patients (17%) presented with an intracerebral or subarachnoid hemorrhage, and 6 patients (4%) presented with a cerebral sinus thrombosis. The median National Institutes of Health Stroke Scale (NIHSS) scores upon presentation for patients with an acute ischemic stroke and intracerebral or subarachnoid hemorrhage were 9.5 (range, 6.0-19.0) and 3.0 (2.0-4.0), respectively.

According to the data, the risk of subsequent stroke in infected patients is 156/17,799 (non-weighted simple pooled analysis, 0.9%). The meta-analysis of data from 43 regions suggested an overall stroke risk to be 0.5% (95% CI, 0.3-0.7%). Independent predictors of stroke were found to be the need for mechanical ventilation (odds ratio [OR], 1.9; 95% CI, 1.1-3.5; P =.028) and ischemic heart disease (OR, 2.5; 95% CI, 1.4-4.7; P =.006). Other statistically significant differences between patients with and without subsequent stroke include age (P <.0001), hypertension (P <.0001), prior history of stroke (P =.003), low platelet count (P <.0001), white blood cell count (P =.01), and C-reactive protein levels (P <.001).

Researchers excluded 25% of the patients from analyses due to lack of validated data, which may have introduced selection bias. Furthermore, researchers did not have a central adjudication in this study. It is possible that clinical severity could be assessed through other parameters that could not be collected because of the high number of centers, partial availability of data, and narrow study time window. Differences in treatment protocol could also not be taken into consideration.


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“There are increasing concern regarding neurological and specifically cerebrovascular complications of SARS-CoV-2,” researchers noted, and understanding the risk and characteristics of these events is therefore critically important. The current data here suggest that despite the increased risk in SARS-CoV-2 patients, it is comparable to other viral infections and critical conditions. Researchers suggest clinicians and nurses monitor critically ill patients for acute stroke symptoms.

Reference

Shahjouei S, Naderi S, Li J, et al. Risk of stroke in hospitalized SARS-CoV-2 infected patients: a multinational study. EBioMedicine. 2020;59:102939.