The Effect of COVID-19 Hospitalisation on the Occurrence of Stroke: A Systematic Review and Meta-Analysis

BackgroundThe relationship between COVID-19 hospitalisation and stroke occurrence remains incompletely understood, with reported incidence rates varying significantly across studies. This systematic review and meta-analysis aimed to comprehensively evaluate the association between COVID-19 hospitalisation and stroke occurrence, while examining key subgroup variations and potential risk factors. MethodsA systematic search was conducted across PubMed, Scopus, and Web of Science databases from December 2019 to 2023. Studies reporting stroke occurrence in hospitalised COVID-19 patients were included. The Newcastle-Ottawa Scale was used for quality assessment. Random-effects meta-analysis was performed to calculate pooled odds ratios (OR) and risk ratios (RR) with 95% confidence intervals (CI). ResultsNineteen studies met the inclusion criteria. The primary meta-analysis of 17 studies, comprising 98,297 patients, revealed a pooled stroke occurrence of 1% (95% CI: 1%,2%). A comparative analysis of three studies showed no significant difference in stroke risk between hospitalised COVID-19 patients and non-COVID-19 hospitalised controls (OR: 1.13, 95% CI: 0.49,2.65). However, within the COVID-19 hospitalised population, stroke risk was strongly associated with disease severity, including the need for mechanical ventilation (OR: 3.59, 95% CI: 2.21,5.83) and ICU admission (OR: 6.33, 95% CI: 4.95, 8.09). Significant pre-existing comorbidities included hypertension (OR: 2.35, 95% CI: 1.12,4.92) and atrial fibrillation (OR: 1.98, 95% CI: 1.18,3.31). Ischemic stroke was the predominant subtype, accounting for 81% of cases (95% CI: 73%,90%). Quality assessment of the 19 studies identified 9 as high quality and 10 as moderate quality. ConclusionsThis meta-analysis indicates that while the overall occurrence of stroke in hospitalised COVID-19 patients is approximately 1%, the risk is not significantly elevated compared to non-COVID-19 hospitalised patients. Instead, stroke occurrence is powerfully driven by the severity of the illness and the presence of traditional vascular risk factors. These findings underscore the critical need for vigilant neurological monitoring and targeted stroke prevention strategies, particularly for COVID-19 patients who require intensive care or mechanical ventilation.