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Stroke in Coronavirus Disease 2019: A Systematic Review

Journal of Stroke 2020년 22권 3호 p.324 ~ 335
Bhatia Rohit, Pedapati Radhakrishna, Komakula Snigdha, Srivastava M. V. Padma, Vishnubhatla Sreenivas, Khuranac Dheeraj,
소속 상세정보
 ( Bhatia Rohit ) - All India Institute of Medical Sciences Department of Neurology
 ( Pedapati Radhakrishna ) - All India Institute of Medical Sciences Department of Neurology
 ( Komakula Snigdha ) - All India Institute of Medical Sciences Department of Neurology
 ( Srivastava M. V. Padma ) - All India Institute of Medical Sciences Department of Neurology
 ( Vishnubhatla Sreenivas ) - All India Institute of Medical Sciences Department of Biostatistics
 ( Khuranac Dheeraj ) - Postgraduate Institute of Medical Education and Research Department of Neurology

Abstract


Background and Purpose: Various neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19.

Methods: Three authors independently searched Web of Science, Embase, Scopus, and PubMed starting from inception up to May 22, 2020. The data for individual patients was extracted where available from published reports including clinical and laboratory parameters and analysed for any significant associations between variables.

Results: We identified 30 relevant articles involving 115 patients with acute or subacute stroke with COVID-19. The mean±standard deviation age was 62.5±14.5 years. Stroke was ischemic in majority of the patients (101 [87.8%]). Hypertension (42 [42%]), dyslipidaemia (24 [26.1%]), and diabetes (23 [23.2%]) were the major vascular risk factors. Most of the patients (80 [85.1%]) had COVID-19 symptoms at the time of stroke with a median interval of 10 days to stroke from the diagnosis of COVID-19. Three-fourths (86 [74.8%]) of the patients were critically ill which frequently delayed the diagnosis of stroke. High levels of D-dimer, and ferritin were observed in these patients. Patients with COVID-19 and stroke had a high mortality (47.9%). Factors associated with mortality were intensive care unit admission, having two or more vascular risk factors, particularly smoking and high levels of D-dimer, C-reactive protein, and lactate dehydrogenase.

Conclusions: The association between stroke and COVID-19 is probably multifactorial including an amalgamation of traditional vascular risk factors, proinflammatory and a prothrombotic state. Prospectively collected data is required in the future to confirm this hypothesis.

키워드

Stroke; COVID-19; Severe acute respiratory syndrome coronavirus 2; Clinical trial; Systematic review; Virus diseases

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