Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): A pooled analysis of published literature

The initial search included 1683 articles of which 6 articles were selected.

4 studies compared cases of patients presenting severe or non-severe cerebrovascular disease with a sample of 1829 confirmed Covid-19 patients (553, 30.2% being severe cases). A total of 29 patients (2.6%) had a history of cerebrovascular disease or stroke.

Two studies including 202 patients (100, 49.5% being non-survivors) compared the rate of cerebrovascular disease in Covid-19 patients who did not survive vs. survived, with 19 or 9.4% classified as non-survivors.

In the four studies on severity, only one study by Wang et al. individually had a significant OR for cerebrovascular disease and COVID-19 severity. However, in pooled analysis, cerebrovascular disease was found to be associated with a statistically significant increased risk of a severe form of COVID-19 (OR: 2.55 (95% CI: 1.18 to 5.51), I^2 = 29%, Cochran’s Q, p = 0.24).

Although heterogeneity was low, a leaveone-out sensitivity analysis was still performed. Only excluding the study by Wang et al. significantly altered the results of the analysis and appeared to be the source of heterogeneity (OR: 1.88 (95% CI: 0.828 to 4.29), I^2 = 0%, Cochran’s Q, p = 0.90). In the limited pooled analysis of mortality studies, a non-significant trend was found when evaluating association of cerebrovascular disease and enhanced risk of mortality in COVID-19 patients (OR: 2.33 (95% CI: 0.77 to 7.04), I^2 = 30%, Cochran’s Q, p = 0.23). In the meta-regression analysis, a non-significant trend was observed between mean age of patients with severe COVID-19 and log odds of cerebrovascular disease and COVID-19 severity (correlation coefficient 0.1582, 95% CI: 0.0575 to 0.3740, p = 0.15). Limited studies prevented a meta-regression for mortality.