Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study

Shahjouei, Shima; Naderi, Soheil; Li, Jiang; Khan, Ayesha; Chaudhary, Durgesh; Farahmand, Ghasem; Male, Shailesh; Griessenauer, Christoph; Sabra, Mirna; Mondello, Stefania; Cernigliaro, Achille; Khodadadi, Faezeh; Dev, Apoorva; Goyal, Nitin; Ranji-Burachaloo, Sakineh; Olulana, Oluwaseyi; Avula, Venkatesh; Ebrahimzadeh, Seyed Amir; Alizada, Orkhan; Hancı, Mehmet Murat; Ghorbani, Askar; Vaghefi far, Alaleh; Ranta, Annemarei; Punter, Martin; Ramezani, Mahtab; Ostadrahimi, Nima; Tsivgoulis, Georgios; Fragkou, Paraskevi C.; Nowrouzi-Sohrabi, Peyman; Karofylakis, Emmanouil; Tsiodras, Sotirios; Neshin Aghayari Sheikh, Saeideh; Saberi, Alia; Niemelä, Mika; Rezai Jahromi, Behnam; Mowla, Ashkan; Mashayekhi, Mahsa; Bavarsad Shahripour, Reza; Sajedi, Seyed Aidin; Ghorbani, Mohammad; Kia, Arash; Rahimian, Nasrin; Abedi, Vida; Zand, Ramin

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.