Significantly higher odds of mortality in stroke-related admissions during COVID-19 pandemic versus pre-COVID/pandemic: A meta-analysis of 455,073 stroke admissions

ABSTRACT

Background: COVID-19, being a prothrombotic state, has been linked to ischemic infarcts. Pooled data on impact of COVID-related stroke on mortality are sparse. We conducted a meta-analysis to assess the risk of stroke-related inpatient mortality (SRIM) during the COVID pandemic vs. pre-pandemic. Methods: Pubmed/Medline, SCOPUS & EMBASE were searched for articles till August 2021 reporting stroke and SRIM during COVID-19 pandemic vs. pre-pandemic. Random-effects model for odds ratio (OR), I2 statistics for heterogeneity assessment and leave-one-out method for sensitivity analysis were employed. Results: A total of 31 studies with 455,073 stroke hospitalizations;365253 pre-pandemic and 89820 pandemics (mean age 72 vs 70 yrs) were analyzed. With a comparable distribution of males, AF, and thrombolysis, the meta-analysis showed a nearly 40% higher risk of mortality during pandemic vs. pre-pandemic admissions (OR 1.42, 95%CI1.06-1.92, p=0.018, I2 =98.59). Further subgroup analysis showed a slightly higher risk of mortality in cohorts with mean age <70 years of age vs. ≥70 yrs [mean <70 years (n=11) OR1.48, p=0.020 vs. ≥70 years (n=17) OR1.27, p<0.001]. Cross-continental subgroup analysis revealed significantly higher mortality in Europe (n=14, OR1.31, p<0.001) during pandemic vs. pre-pandemic, and non-significantly higher association in Asia (OR 1.13, p=0.57), USA (OR 1.59, p=0.23), Africa (OR 1.20, p=0.46) (Fig. 1). Subgroup analysis of 16 studies with n=100-1000 showed significantly higher OR (1.31) for SRIM during the pandemic vs. pre-pandemic, whereas studies with n<100 or >1000 did not show any significant difference. Sensitivity analysis showed overall and subgroup stability in OR. Conclusions: This largest meta-analysis to date on the subject found that hospitalized stroke patients, elderly or non-elderly, had nearly 40% higher risk of mortality during the COVID pandemic vs. pre-COVID era across the globe, more significantly in Europe. (Figure Presented).