A Meta-analysis of the Impact of COVID-19 on Stroke Mortality

doi:10.12114/j.issn.1007-9572.2022.0480

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (03): 348-355.DOI: 10.12114/j.issn.1007-9572.2022.0480

Special Issue: 新型冠状病毒肺炎最新文章合辑；神经系统疾病最新文章合辑； COVID-19疫情防控研究；脑健康最新研究合辑

• Evidence-based Medicine • Previous Articles Next Articles

A Meta-analysis of the Impact of COVID-19 on Stroke Mortality

1.Graduate School, Hebei North University, Zhangjiakou 075000, China
2.Department of Neurology, Hebei General Hospital, Shijiazhuang 050051, China
3.Graduate School, North China University of Science and Technology, Tangshan 063210, China
4.Graduate School, Hebei Medical University, Shijiazhuang 050017, China

Received:2022-03-31 Revised:2022-09-20 Published:2023-01-20 Online:2022-10-27
Contact: LI Litao
About author:
HUANGFU X J, LI X J, CHEN M, et al. A meta-analysis of the impact of COVID-19 on stroke mortality [J] . Chinese General Practice, 2023, 26 (3) : 348-355.

新型冠状病毒感染对脑卒中患者病死率影响的Meta分析

1．075000　河北省张家口市，河北北方学院研究生院
2．050051　河北省石家庄市，河北省人民医院神经内科
3．063210　河北省唐山市，华北理工大学研究生院
4．050017　河北省石家庄市，河北医科大学研究生院

通讯作者: 李俐涛
作者简介:
皇甫晓娟，李小娟，陈敏，等.新型冠状病毒肺炎对脑卒中患者病死率影响的Meta分析[J].中国全科医学，2023，26（3）：348-355. [www.chinagp.net] 作者贡献：皇甫晓娟负责文章的构思与设计、论文撰写；皇甫晓娟、李小娟、陈敏、刘吉红、翟蕊、蔡志鹏负责数据收集与整理、统计学处理、结果的分析与解释；李俐涛负责论文的修订、文章质量控制与审校。
基金资助:
河北省政府资助临床优秀人才培养项目(201906)

1. .png(596KB)

Abstract

Abstract:

Background

The COVID-19 pandemic seriously affects human health and life. COVID-19 has been reportedly associated with a high risk of thrombotic events, which are closely associated with stroke.

Objective

To assess the effect and possible mechanism of COVID-19 on stroke morbidity, providing a reliable theoretical basis for scientific prevention and treatment of COVID-19 in stroke.

Methods

We searched databases of Web of Science, PubMed, EmBase, Cochrane Library, CNKI and Wanfang Data for cohort studies and case-control studies related to COVID-19 and stroke published from December 2019 to January 2022. Two researchers conducted literature screening and data extraction separately. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Meta-analysis was used to evaluate the impact of COVID-19 on stroke mortality. Funnel plot was used to evaluate the potential publication bias.

Results

A total of 18 studies were included, 12 of them were of good quality, and other 6 were of fair quality. Meta-analysis showed that stroke patients with COVID-19 had higher mortality〔RR=4.16, 95%CI (2.82, 6.13) , P<0.000 01〕, prolonged prothrombin time (PT) 〔MD=0.78, 95%CI (0.35, 1.20) , P=0.000 3〕, higher D-dimer level〔MD=1.34, 95%CI (0.83, 1.84) , P<0.000 01〕 and higher NIHSS score〔MD=6.66, 95%CI (4.54, 8.79) , P<0.000 01〕, as well as younger age〔MD=-2.04, 95%CI (-3.48, -0.61) , P=0.005〕than those without COVID-19. There was no statistically significant difference in activated partial thromboplastin time between stroke patients with and without COVID-19〔MD=2.51, 95%CI (-2.69, 7.71) , P=0.34〕. Funnel plot assessing potential publication bias in the impact of COVID-19 on stroke mortality was basically symmetrical.

Conclusion

COVID-19 could increase the risk of stroke mortality, which may be related to alterations in the coagulation system manifested by abnormal PT and D-dimer level and so on. And the outcomes of stroke patients with COVID-19 were associated with age and NIHSS score at admission.

Key words: COVID-19, Stroke, Cerebrovascular disorders, Mortality, Cohort studies, Case-control studies, Meta-analysis, Systematic reviews

摘要：

背景

新型冠状病毒感染（COVID-19）在全球范围蔓延，严重影响人类健康和生活。有研究报道COVID-19可导致血栓性疾病，而脑卒中与血栓事件密切相关。

目的

评估COVID-19对脑卒中患者病死率的影响，并对其可能机制进行探讨，从而为合并COVID-19的脑卒中患者的科学防治提供可靠的临床理论依据。

方法

计算机检索PubMed、EmBase、Web of Science、Cochrane Library、中国知网及万方数据知识服务平台等数据库，收集关于COVID-19对脑卒中患者病死率影响的队列研究或病例对照研究，检索时间为2019年12月至2022年1月。2名研究人员独立进行文献筛选、资料提取，采用纽卡斯尔-渥太华量表（NOS）对文献质量进行评估。采用Meta分析评价COVID-19对脑卒中患者病死率的影响，采用漏斗图评价文献发表偏倚。

结果

共纳入18篇文献，12篇文献质量为高质量，6篇文献质量为中等质量。Meta分析结果显示，合并COVID-19的脑卒中患者病死率、凝血酶原时间（PT）、D-二聚体水平、美国国立卫生研究院卒中量表（NIHSS）评分高于未合并COVID-19的脑卒中患者〔RR=4.16，95%CI（2.82，6.13），P<0.000 01；MD=0.78，95%CI（0.35，1.20），P=0.000 3；MD=1.34，95%CI（0.83，1.84），P<0.000 01；MD=6.66，95%CI（4.54，8.79），P<0.000 01〕，年龄低于未合并COVID-19的脑卒中患者〔MD=-2.04，95%CI（-3.48，-0.61），P=0.005〕。合并COVID-19的脑卒中患者和未合并COVID-19的脑卒中患者活化部分凝血活酶时间（APTT）比较，差异无统计学意义〔MD=2.51，95%CI（-2.69，7.71），P=0.34〕。对合并COVID-19脑卒中患者的病死率绘制漏斗图，结果显示两侧基本对称分布。

结论

COVID-19可增加脑卒中患者病死率，PT、D-二聚体等凝血系统指标的改变可能在其中发挥重要的作用，其预后与年龄、入院时NIHSS评分等相关。

关键词: 新型冠状病毒感染, 卒中, 脑血管障碍, 死亡率, 队列研究, 病例对照研究, Meta分析, 系统评价

HUANGFU Xiaojuan,LI Xiaojuan,CHEN Min, et al. A Meta-analysis of the Impact of COVID-19 on Stroke Mortality[J]. Chinese General Practice, 2023, 26(03): 348-355. DOI: 10.12114/j.issn.1007-9572.2022.0480.
皇甫晓娟,李小娟,陈敏等. 新型冠状病毒感染对脑卒中患者病死率影响的Meta分析[J]. 中国全科医学, 2023, 26(03): 348-355. DOI: 10.12114/j.issn.1007-9572.2022.0480.

Figures/Tables 11

References 48

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第一作者	发表年份（年）	平均年龄（岁）		样本量（例）		住院死亡人数（例）		研究类型	结局指标
第一作者	发表年份（年）	病例组	对照组	病例组	对照组	病例组	对照组	研究类型	结局指标
DHAMOON^[16]	2021	65.9±14.3	66.7±15.5	105	172	35	22	队列研究	①②③④⑤⑥
QURESHI^[17]	2021	68.8±15.1	71±14.9	8 163	199	—	—	队列研究	①⑥
KATZ^[18]	2020	—	—	86	499	25	45	队列研究	①
BHATIA^[19]	2021	58.25±15.19	60.59±14.71	52	355	22	27	病例对照研究	①⑥
MEHRPOUR^[20]	2020	75.60±9.54	60.86±18.45	10	21	3	2	病例对照研究	①④⑥
PABLO^[21]	2020	70.2±8.4	70.1±15.3	19	81	5	5	病例对照	①⑥
MATHEW^[22]	2021	55.66±13.20	57.21±11.97	60	104	13	0	病例对照研究	①⑤⑥
MARTÍ-FÀBREGAS^[23]	2021	71.6±12.3	72.4±13.5	91	610	38	98	队列研究	①④⑥
BEKELIS^[24]	2020	—	—	2 513	22 295	—	—	队列研究	①
LIN^[25]	2020	58.2±18.3	65.9±13.9	9	51	4	4	病例对照研究	①②③⑤⑥
TOPCUOGLU^[26]	2021	—	—	37	355	18	22	病例对照研究	①③④⑤
PERRY^[27]	2020	—	—	23	177	—	—	病例对照研究	④
JOHN^[28]	2020	48.1±10.8	58.7 ±14.5	19	220	1	4	病例对照研究	①③⑤⑥
WANG^[29]	2021	—	—	124	226	34	5	队列研究	①
CIOLLI^[30]	2021	—	—	26	111	7	10	病例对照研究	①
GARCÍA-LAMBERECHTS^[31]	2021	—	—	74 814	1 388 879	—	—	队列研究	①②④
KVERNLAND^[32]	2020	—	—	32	46	14	4	队列研究	①
BENUSSI^[33]	2020	—	—	43	68	15	4	队列研究	②

第一作者	发表年份（年）	平均年龄（岁）		样本量（例）		住院死亡人数（例）		研究类型	结局指标
第一作者	发表年份（年）	病例组	对照组	病例组	对照组	病例组	对照组	研究类型	结局指标
DHAMOON^[16]	2021	65.9±14.3	66.7±15.5	105	172	35	22	队列研究	①②③④⑤⑥
QURESHI^[17]	2021	68.8±15.1	71±14.9	8 163	199	—	—	队列研究	①⑥
KATZ^[18]	2020	—	—	86	499	25	45	队列研究	①
BHATIA^[19]	2021	58.25±15.19	60.59±14.71	52	355	22	27	病例对照研究	①⑥
MEHRPOUR^[20]	2020	75.60±9.54	60.86±18.45	10	21	3	2	病例对照研究	①④⑥
PABLO^[21]	2020	70.2±8.4	70.1±15.3	19	81	5	5	病例对照	①⑥
MATHEW^[22]	2021	55.66±13.20	57.21±11.97	60	104	13	0	病例对照研究	①⑤⑥
MARTÍ-FÀBREGAS^[23]	2021	71.6±12.3	72.4±13.5	91	610	38	98	队列研究	①④⑥
BEKELIS^[24]	2020	—	—	2 513	22 295	—	—	队列研究	①
LIN^[25]	2020	58.2±18.3	65.9±13.9	9	51	4	4	病例对照研究	①②③⑤⑥
TOPCUOGLU^[26]	2021	—	—	37	355	18	22	病例对照研究	①③④⑤
PERRY^[27]	2020	—	—	23	177	—	—	病例对照研究	④
JOHN^[28]	2020	48.1±10.8	58.7 ±14.5	19	220	1	4	病例对照研究	①③⑤⑥
WANG^[29]	2021	—	—	124	226	34	5	队列研究	①
CIOLLI^[30]	2021	—	—	26	111	7	10	病例对照研究	①
GARCÍA-LAMBERECHTS^[31]	2021	—	—	74 814	1 388 879	—	—	队列研究	①②④
KVERNLAND^[32]	2020	—	—	32	46	14	4	队列研究	①
BENUSSI^[33]	2020	—	—	43	68	15	4	队列研究	②

第一作者	研究人群的选择	组间可比性	暴露因素测量	总分
DHAMOON^[16]	3	2	3	8
QURESHI^[17]	4	1	1	6
KATZ^[18]	4	1	0	5
MARTÍ-FÀBREGAS^[23]	4	0	3	7
BEKELIS^[24]	4	0	2	6
WANG^[29]	4	0	2	6
GARCÍA-LAMBERECHTS^[31]	4	2	3	9
KVERNLAND^[32]	4	1	1	6
BENUSSI^[33]	4	2	2	8

第一作者	研究人群的选择	组间可比性	暴露因素测量	总分
DHAMOON^[16]	3	2	3	8
QURESHI^[17]	4	1	1	6
KATZ^[18]	4	1	0	5
MARTÍ-FÀBREGAS^[23]	4	0	3	7
BEKELIS^[24]	4	0	2	6
WANG^[29]	4	0	2	6
GARCÍA-LAMBERECHTS^[31]	4	2	3	9
KVERNLAND^[32]	4	1	1	6
BENUSSI^[33]	4	2	2	8

第一作者	研究人群的选择	组间可比性	暴露因素测量	总分
BHATIA^[19]	4	1	1	6
MEHRPOUR^[20]	4	1	2	7
PABLO^[21]	4	1	2	7
MATHEW^[22]	4	2	2	8
LIN^[25]	4	1	3	8
TOPCUOGLU^[26]	3	2	2	7
PERRY^[27]	3	2	2	7
JOHN^[28]	4	2	3	9
CIOLLI^[30]	4	2	2	8

A Meta-analysis of the Impact of COVID-19 on Stroke Mortality

新型冠状病毒感染对脑卒中患者病死率影响的Meta分析

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