Abstract
ObjectiveTo determine whether a history of cerebrovascular disease (CVD) increases risk of severe coronavirus disease 2019 (COVID-19).MethodsIn a retrospective multicenter study, we retrieved individual data from in-patients treated March 1 to April 15, 2020 from COVID-19 registries of three hospitals in Saxony, Germany. We also performed a systematic review and meta-analysis following PRISMA recommendations using PubMed, EMBASE, Cochrane Library databases and bibliographies of identified papers (last search on April 11, 2020) and pooled data with those deriving from our multicenter study. Of 3762 records identified, 11 eligible observational studies of laboratory-confirmed COVID-19 patients were included in quantitative data synthesis.Risk ratios (RR) of severe COVID-19 according to history of CVD were pooled using DerSimonian and Laird random effects model. Between-study heterogeneity was assessed using Cochran’s Q and I2-statistics. Severity of COVID-19 according to definitions applied in included studies was the main outcome. Sensitivity analyses were conducted for clusters of studies with equal definitions of severity.ResultsPooled analysis included data from 1906 laboratory-confirmed COVID-19 patients (43.9% females, median age ranging from 39 to 76 years). Patients with previous CVD had higher risk of severe COVID-19 than those without [RR 2.07, 95% confidence interval (CI) 1.52–2.81; p < 0.0001]. This association was also observed in clusters of studies that defined severe manifestation of the disease by clinical parameters (RR 1.44, 95% CI 1.22–1.71; p < 0.0001), necessity of intensive care (RR 2.79, 95% CI 1.83–4.24; p < 0.0001) and in-hospital death (RR 2.18, 95% CI 1.75–2.7; p < 0.0001).ConclusionA history of CVD might constitute an important risk factor of unfavorable clinical course of COVID-19 suggesting a need of tailored infection prevention and clinical management strategies for this population at risk.
Highlights
Rapid transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a case fatality rate that is up to 40 times higher than mortality of seasonal influenzaElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Extended author information available on the last page of the article make coronavirus disease 2019 a global threat [1, 2]
A history of cerebrovascular disease (CVD) was found to be more frequent in patients with severe COVID-19 when severity was defined by necessity of intensive care vs. regular in-patient care (30.4% vs. 11.5%, p = 0.047) and in-hospital death vs. survival (35% vs. 11.4%, p = 0.02)
The major finding of our multicenter study is that a history of CVD is associated with an increased risk of developing severe course of COVID-19
Summary
Rapid transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a case fatality rate that is up to 40 times higher than mortality of seasonal influenza. Extended author information available on the last page of the article make coronavirus disease 2019 a global threat [1, 2] The latter is largely explained by high risk of acute respiratory distress syndrome as well as sepsis, multi-organ failure and disseminated intravascular coagulopathy, which is most pronounced in the elderly and in premorbid patients with a cardiovascular risk profile [3, 4]. The importance of cerebrovascular disease (CVD) in the clinical course of COVID-19 is poorly understood This is a relevant research gap as patients with CVD are vulnerable toward pulmonary and inflammatory complications due to their frequent disability [8, 9]. In order to assess consistency among regions and increase generalizability of our findings, we went on to pool our data with published data of COVID-19 patients who were being treated in Wuhan and other regions in China
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