Open Access
Open access
volume 59 pages 102939

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

Shima Shahjouei 1
Soheil Naderi 2, 3
Jiang Li 4
Ayesha Khan 1
Durgesh Chaudhary 1
Ghasem Farahmand 5
Shailesh S. Male 6
Christoph J. Griessenauer 1
Mirna Sabra 7
Stefania Mondello 8
Achille Cernigliaro 9
Faezeh Khodadadi 10
Apoorva Dev 10
Nitin Goyal 11
Sakineh Ranji-Burachaloo 5
Oluwaseyi Olulana 1
Venkatesh Avula 1
Seyed Amir Ebrahimzadeh 12
Orkhan Alizada 13
Murat Hanci 13
Askar Ghorbani 5
Alaleh Vaghefi Far 14
A. Ranta 14, 15
Martin Punter 14, 15
Mahtab Ramezani 16
Nima Ostadrahimi 3
Georgios Tsivgoulis 11, 17
Paraskevi Fragkou 18
Peyman Nowrouzi-Sohrabi 19
Emmanouil Karofylakis 18
Saeideh Neshin Aghayari Sheikh 20
Alia Saberi 20
Mika Niemelä 21
Behnam Rezai Jahromi 21
A. Mowla 22
Mahsa Mashayekhi 23
Reza Bavarsad Shahripour 11
Seyed Aidin Sajedi 24
Mohammad Ghorbani 25
Arash Kia 26
Nasrin Rahimian 27
Vida Abedi 28, 29
R. Zand 2, 11
1
 
Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA.
2
 
Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA
4
 
Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, USA.
6
 
Neurology Department, Vidant Medical Center, Greenville, NC, USA
9
 
Regional Health Authority of Sicily, Palermo, Italy
12
 
Radiology Department, Yasrebi Hospital, Kashan, Iran
14
 
Department of Neurology, Wellington Hospital, Wellington, New Zealand
27
 
Neurology Department, Yasrebi Hospital, Kashan, Iran
29
 
Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, USA
Publication typeJournal Article
Publication date2020-09-01
scimago Q1
wos Q1
SJR3.591
CiteScore17.1
Impact factor10.8
ISSN23523964
General Biochemistry, Genetics and Molecular Biology
General Medicine
Abstract

Abstract

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.
Found 
Found 

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GOST Copy
Shahjouei S. et al. Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study // EBioMedicine. 2020. Vol. 59. p. 102939.
GOST all authors (up to 50) Copy
Shahjouei S., Naderi S., Li J., Khan A., Chaudhary D., Farahmand G., Male S. S., Griessenauer C. J., Sabra M., Mondello S., Cernigliaro A., Khodadadi F., Dev A., Goyal N., Ranji-Burachaloo S., Olulana O., Avula V., Ebrahimzadeh S. A., Alizada O., Hanci M., Ghorbani A., Vaghefi Far A., Ranta A., Punter M., Ramezani M., Ostadrahimi N., Tsivgoulis G., Fragkou P., Nowrouzi-Sohrabi P., Karofylakis E., Tsiodras S., Neshin Aghayari Sheikh S., Saberi A., Niemelä M., Rezai Jahromi B., Mowla A., Mashayekhi M., Bavarsad Shahripour R., Sajedi S. A., Ghorbani M., Kia A., Rahimian N., Abedi V., Zand R. Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study // EBioMedicine. 2020. Vol. 59. p. 102939.
RIS |
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RIS Copy
TY - JOUR
DO - 10.1016/j.ebiom.2020.102939
UR - https://doi.org/10.1016/j.ebiom.2020.102939
TI - Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study
T2 - EBioMedicine
AU - Shahjouei, Shima
AU - Naderi, Soheil
AU - Li, Jiang
AU - Khan, Ayesha
AU - Chaudhary, Durgesh
AU - Farahmand, Ghasem
AU - Male, Shailesh S.
AU - Griessenauer, Christoph J.
AU - Sabra, Mirna
AU - Mondello, Stefania
AU - Cernigliaro, Achille
AU - Khodadadi, Faezeh
AU - Dev, Apoorva
AU - Goyal, Nitin
AU - Ranji-Burachaloo, Sakineh
AU - Olulana, Oluwaseyi
AU - Avula, Venkatesh
AU - Ebrahimzadeh, Seyed Amir
AU - Alizada, Orkhan
AU - Hanci, Murat
AU - Ghorbani, Askar
AU - Vaghefi Far, Alaleh
AU - Ranta, A.
AU - Punter, Martin
AU - Ramezani, Mahtab
AU - Ostadrahimi, Nima
AU - Tsivgoulis, Georgios
AU - Fragkou, Paraskevi
AU - Nowrouzi-Sohrabi, Peyman
AU - Karofylakis, Emmanouil
AU - Tsiodras, Sotirios
AU - Neshin Aghayari Sheikh, Saeideh
AU - Saberi, Alia
AU - Niemelä, Mika
AU - Rezai Jahromi, Behnam
AU - Mowla, A.
AU - Mashayekhi, Mahsa
AU - Bavarsad Shahripour, Reza
AU - Sajedi, Seyed Aidin
AU - Ghorbani, Mohammad
AU - Kia, Arash
AU - Rahimian, Nasrin
AU - Abedi, Vida
AU - Zand, R.
PY - 2020
DA - 2020/09/01
PB - Elsevier
SP - 102939
VL - 59
PMID - 32818804
SN - 2352-3964
ER -
BibTex
Cite this
BibTex (up to 50 authors) Copy
@article{2020_Shahjouei,
author = {Shima Shahjouei and Soheil Naderi and Jiang Li and Ayesha Khan and Durgesh Chaudhary and Ghasem Farahmand and Shailesh S. Male and Christoph J. Griessenauer and Mirna Sabra and Stefania Mondello and Achille Cernigliaro and Faezeh Khodadadi and Apoorva Dev and Nitin Goyal and Sakineh Ranji-Burachaloo and Oluwaseyi Olulana and Venkatesh Avula and Seyed Amir Ebrahimzadeh and Orkhan Alizada and Murat Hanci and Askar Ghorbani and Alaleh Vaghefi Far and A. Ranta and Martin Punter and Mahtab Ramezani and Nima Ostadrahimi and Georgios Tsivgoulis and Paraskevi Fragkou and Peyman Nowrouzi-Sohrabi and Emmanouil Karofylakis and Sotirios Tsiodras and Saeideh Neshin Aghayari Sheikh and Alia Saberi and Mika Niemelä and Behnam Rezai Jahromi and A. Mowla and Mahsa Mashayekhi and Reza Bavarsad Shahripour and Seyed Aidin Sajedi and Mohammad Ghorbani and Arash Kia and Nasrin Rahimian and Vida Abedi and R. Zand},
title = {Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study},
journal = {EBioMedicine},
year = {2020},
volume = {59},
publisher = {Elsevier},
month = {sep},
url = {https://doi.org/10.1016/j.ebiom.2020.102939},
pages = {102939},
doi = {10.1016/j.ebiom.2020.102939}
}