Meta-analysis Of The Effect Of COVID-19 Infection On The Morbidity And Mortality Of Stroke

ObjectiveNovel Coronavirus disease 2019(COVID-19)is spreading globally,seriously affecting human health and life.It has been reported that COVID-19 infection can lead to thrombotic disease,and stroke is closely related to thrombotic events.Will COVID-19 infection promote the increase of stroke incidence?Does it affect the prognosis of stroke?The mechanism of interaction between the two is still unclear.This study aims to conduct a meta-analysis on this global concern,further evaluate the impact of COVID-19 infection on the morbidity and mortality of stroke by analyzing the relationship between COVID-19 infection and stroke,and explore its possible mechanism,so as to provide a reliable clinical theoretical basis for the scientific prevention and treatment of COVID-19 patients.MethodsThrough the retrieval of Web of Science,Pubmed,Embase,Cochrane,China National Knowledge Infrastructure(CNKI)and Wanfang databases,The searches were performed between December 2019 and January 2022using medical subject heading(MESH)terms and free words,both consistent with Boolean operators.Medical subject words are"COVID-19,stroke or novel Coronavirus,stroke,cerebrovascular disease,etc.".Without language restrictions,observational and interventional studies caused by COVID-19infection were selected,excluding case reports and review series.The primary outcome was stroke morbidity and mortality in COVID-19 patients.ResultsA total of 20 literatures were included in this study,and the results of meta-analysis showed that:1 Impact of COVID-19 infection on stroke incidence:Six studies were included,and meta-analysis showed that COVID-19 infection had no significant increase in stroke incidence compared with non-COVID-19infected patients(RR=1.59,95%CI:0.58-4.35,P=0.37).2 Impact of COVID-19 infection on stroke mortality:Sixteen studies were included,and meta-analysis showed a statistically significant higher risk of death among stroke patients compared with non-infected patients(RR=4.16,95%CI:2.82-6.13,I~2=83%,P<0.001).3 Effect of COVID-19 infection on Prothrombin time(PT):Four studies were included,and meta-analysis showed that PT was significantly higher in patients with stroke than in patients without COVID-19,with statistically significant differences(MD=0.93,95%CI:0.26-1.60,I~2=50%,P=0.007).4 The effect of Activated partial thromboplastin Time(APTT)on COVID-19 infection:A total of 4 studies were included,and meta-analysis showed no significant difference in APTT between stroke patients who were not infected and those who were infected with COVID-19(MD=-0.09,95%CI:-1.86-1.69,I~2=83%,P=0.93).5 Effects of COVID-19 infection on D-dimer:A total of 6 studies were included,and meta-analysis showed that d-dimer was significantly increased in patients with stroke compared with those without COVID-19,with statistically significant differences(MD=1.34,95%CI:0.83-1.84,I~2=54%,P<0.001).ConclusionsStudies have shown no significant correlation between COVID-19infection and stroke incidence.COVID-19 infection can increase the mortality of stroke,and PT,D-dimer and other coagulation system changes may play an important role in this mechanism.