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Risk of Stroke in Hospitalized Sars-Cov-2 Infected Patients: A Multinational Study Publisher Pubmed



Shahjouei S1 ; Naderi S1, 28 ; Li J2 ; Khan A1 ; Chaudhary D1 ; Farahmand G3, 12 ; Male S4 ; Griessenauer C1 ; Sabra M5 ; Mondello S6 ; Cernigliaro A7 ; Khodadadi F8 ; Dev A8 ; Goyal N9 Show All Authors
Authors
  1. Shahjouei S1
  2. Naderi S1, 28
  3. Li J2
  4. Khan A1
  5. Chaudhary D1
  6. Farahmand G3, 12
  7. Male S4
  8. Griessenauer C1
  9. Sabra M5
  10. Mondello S6
  11. Cernigliaro A7
  12. Khodadadi F8
  13. Dev A8
  14. Goyal N9
  15. Ranjiburachaloo S3, 12
  16. Olulana O1
  17. Avula V1
  18. Ebrahimzadeh SA10
  19. Alizada O11
  20. Hanci MM11
  21. Ghorbani A12
  22. Vaghefi Far A13
  23. Ranta A13, 14
  24. Punter M13, 14
  25. Ramezani M15
  26. Ostadrahimi N28
  27. Tsivgoulis G9, 16
  28. Fragkou PC17
  29. Nowrouzisohrabi P18
  30. Karofylakis E17
  31. Tsiodras S17
  32. Neshin Aghayari Sheikh S19
  33. Saberi A19
  34. Niemela M20
  35. Rezai Jahromi B20
  36. Mowla A21
  37. Mashayekhi M22
  38. Bavarsad Shahripour R9
  39. Sajedi SA23
  40. Ghorbani M24
  41. Kia A25
  42. Rahimian N26
  43. Abedi V2, 27
  44. Zand R1, 9

Source: EBioMedicine Published:2020


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. © 2020 The Authors
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