The relationship between COVID-19’s severity and ischemic stroke: a systematic review and meta-analysis

Objective We aim to determine the risk of acute ischemic stroke in patients with severe and non-severe coronavirus disease 2019 (COVID-19). Methods A literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases until October 28, 2020. Studies covering COVID-19’s severity classification data and COVID-19 patients with acute ischemic stroke were included. Two independent evaluators extracted data, and the random effects model was used to calculate the risk ratios (RR) and 95% confidence interval (95% CI) of acute ischemic stroke associated with COVID-19’s severity. Results A total of 8 studies were included, involving 5266 patients. Among all COVID-19 patients, the total incidence of ischemic stroke was 1.76% (95% CI: 0.82–3.01). Severe patients have an increased risk of acute ischemic stroke compared with non-severe patients (RR = 3.53, 95% CI: 2.06–6.07, P < 0.0001; I 2 = 12%). This association was also observed when COVID-19’s severity was defined by clinical parameters (RR 2.91, 95% CI: 1.17–7.26, P = 0.02; I 2 = 29%) and the need for intensive care (RR 4.47, 95% CI: 2.40–8.31, P < 0.0001; I 2 = 0%). Conclusions This meta-analysis shows that the severe course of COVID-19 is associated with an increased risk of acute ischemic stroke.