EBioMedicine (Sep 2020)
Risk of stroke in hospitalized SARS-CoV-2 infected patients: A multinational study
- Shima Shahjouei,
- Soheil Naderi,
- Jiang Li,
- Ayesha Khan,
- Durgesh Chaudhary,
- Ghasem Farahmand,
- Shailesh Male,
- Christoph Griessenauer,
- Mirna Sabra,
- Stefania Mondello,
- Achille Cernigliaro,
- Faezeh Khodadadi,
- Apoorva Dev,
- Nitin Goyal,
- Sakineh Ranji-Burachaloo,
- Oluwaseyi Olulana,
- Venkatesh Avula,
- Seyed Amir Ebrahimzadeh,
- Orkhan Alizada,
- Mehmet Murat Hancı,
- Askar Ghorbani,
- Alaleh Vaghefi far,
- Annemarei Ranta,
- Martin Punter,
- Mahtab Ramezani,
- Nima Ostadrahimi,
- Georgios Tsivgoulis,
- Paraskevi C. Fragkou,
- Peyman Nowrouzi-Sohrabi,
- Emmanouil Karofylakis,
- Sotirios Tsiodras,
- Saeideh Neshin Aghayari Sheikh,
- Alia Saberi,
- Mika Niemelä,
- Behnam Rezai Jahromi,
- Ashkan Mowla,
- Mahsa Mashayekhi,
- Reza Bavarsad Shahripour,
- Seyed Aidin Sajedi,
- Mohammad Ghorbani,
- Arash Kia,
- Nasrin Rahimian,
- Vida Abedi,
- Ramin Zand
Affiliations
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA
- Soheil Naderi
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA; Neurosurgery Department, Tehran University of Medical Sciences, Tehran, Iran
- Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, USA
- Ayesha Khan
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA
- Durgesh Chaudhary
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA
- Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
- Shailesh Male
- Neurology Department, Vidant Medical Center, Greenville, NC, USA
- Christoph Griessenauer
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA
- Mirna Sabra
- Neurosciences Research Center (NRC), Lebanese University/ Medical School, Beirut, Lebanon
- Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
- Achille Cernigliaro
- Regional Health Authority of Sicily, Palermo, Italy
- Faezeh Khodadadi
- PES University, Bengaluru, Karnataka, India
- Apoorva Dev
- PES University, Bengaluru, Karnataka, India
- Nitin Goyal
- Neurology Department, University of Tennessee Health Science Center, Tennessee, USA
- Sakineh Ranji-Burachaloo
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
- Oluwaseyi Olulana
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA
- Venkatesh Avula
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA
- Seyed Amir Ebrahimzadeh
- Radiology Department, Yasrebi Hospital, Kashan, Iran
- Orkhan Alizada
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
- Mehmet Murat Hancı
- Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
- Askar Ghorbani
- Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
- Alaleh Vaghefi far
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
- Annemarei Ranta
- Department of Neurology, Wellington Hospital, Wellington, New Zealand; Department of Medicine, University of Otago, Wellington, New Zealand
- Martin Punter
- Department of Neurology, Wellington Hospital, Wellington, New Zealand; Department of Medicine, University of Otago, Wellington, New Zealand
- Mahtab Ramezani
- Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Nima Ostadrahimi
- Neurosurgery Department, Tehran University of Medical Sciences, Tehran, Iran
- Georgios Tsivgoulis
- Neurology Department, University of Tennessee Health Science Center, Tennessee, USA; Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
- Paraskevi C. Fragkou
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Peyman Nowrouzi-Sohrabi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Emmanouil Karofylakis
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Saeideh Neshin Aghayari Sheikh
- Neurology Department, Poursina Hospital, Guilan University of Medical Sciences, Guilan, Iran
- Alia Saberi
- Neurology Department, Poursina Hospital, Guilan University of Medical Sciences, Guilan, Iran
- Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
- Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
- Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, California, USA
- Mahsa Mashayekhi
- Internal medicine Department, Tabriz University of medical sciences, Tabriz, Iran
- Reza Bavarsad Shahripour
- Neurology Department, University of Tennessee Health Science Center, Tennessee, USA
- Seyed Aidin Sajedi
- Neuroscience Research Center, Department of Neurology, Golestan University of Medical Sciences, Gorgan, Iran
- Mohammad Ghorbani
- Divisions of Vascular and Endovascular Neurosurgery and Neurology, Firoozgar Hospital and Rasoul-Akram hospital, Iran University of Medical Sciences, Tehran, Iran
- Arash Kia
- Icahn school of medicine at Mount Sinai, Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, New York, USA
- Nasrin Rahimian
- Neurology Department, Yasrebi Hospital, Kashan, Iran
- Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA, USA; Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia, USA
- Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA, USA; Neurology Department, University of Tennessee Health Science Center, Tennessee, USA; Corresponding author at: Neurology Department, Neuroscience Institute, Geisinger Health System, 100 North Academy Ave. Danville, PA 17822, USA.
- Journal volume & issue
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Vol. 59
p. 102939
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.
