Association Between Previous Stroke and Severe COVID-19: A Retrospective Cohort Study and an Overall Review of Meta-Analysis

Huayao Huang; Junnian Chen; Shuangfang Fang; Xiaoling Chen; Xiaobin Pan; Hanhan Lei; Yixian Zhang; Hailong Lin; Qilin Yuan; Pincang Xia; Nan Liu; Houwei Du

doi:10.3389/fneur.2022.922936

Association Between Previous Stroke and Severe COVID-19: A Retrospective Cohort Study and an Overall Review of Meta-Analysis

Front Neurol. 2022 Jul 12:13:922936. doi: 10.3389/fneur.2022.922936. eCollection 2022.

Authors

Huayao Huang¹, Junnian Chen², Shuangfang Fang³, Xiaoling Chen⁴, Xiaobin Pan⁵, Hanhan Lei³, Yixian Zhang¹, Hailong Lin⁶, Qilin Yuan³, Pincang Xia⁷, Nan Liu^{1

3}, Houwei Du³

Affiliations

¹ Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, China.
² Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China.
³ Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China.
⁴ Department of Infectious Disease, Fujian Medical University Union Hospital, Fuzhou, China.
⁵ Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, Fuzhou, China.
⁶ Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.
⁷ Fujian Center for Disease Control and Prevention, Fuzhou, China.

Abstract

Objective: The objective of this study was to investigate the association between previous stroke and the risk of severe coronavirus disease 2019 (COVID-19).

Methods: We included 164 (61.8 ± 13.6 years) patients with COVID-19 in a retrospective study. We evaluated the unadjusted and adjusted associations between previous stroke and severe COVID-19, using a Cox regression model. We conducted an overall review of systematic review and meta-analysis to investigate the relationship of previous stroke with the unfavorable COVID-19 outcomes.

Results: The rate of severe COVID-19 in patients with previous stroke was 28.37 per 1,000 patient days (95% confidence interval [CI]: 10.65-75.59), compared to 3.94 per 1,000 patient days (95% CI: 2.66-5.82) in those without previous stroke (p < 0.001). Previous stroke was significantly associated with severe COVID-19 using a Cox regression model (unadjusted [hazard ratio, HR]: 6.98, 95% CI: 2.42-20.16, p < 0.001; adjusted HR [per additional 10 years]: 4.62, 95% CI: 1.52-14.04, p = 0.007). An overall review of systematic review and meta-analysis showed that previous stroke was significantly associated with severe COVID-19, mortality, need for intensive care unit admission, use of mechanical ventilation, and an unfavorable composite outcome.

Conclusion: Previous stroke seems to influence the course of COVID-19 infection; such patients are at high risk of severe COVID-19 and might benefit from early hospital treatment measures and preventive strategies.

Keywords: cerebrovascular disease; coronavirus disease 2019; outcome; overall review; stroke.