Prognosis of the post COVID-19 stroke based on D-dimer and inflammatory markers: A mixed model meta-regression analysis

Abstract

Background & Objective: With regard to the importance of inflammatory biomarker and stroke in COVID-19 prognosis, this study aims to compare the mortality of stroke in COVID-19 patients based on the level of inflammatory biomarkers, considering the temporality of stroke occurrence after COVID-19 infection. Methods: As a secondary study, aggregate data were collected by a systematic review. Mixed model meta-regression analyses were conducted to study the effects of stroke, inflammatory biomarkers and D-dimer on mortality of patient with COVID-19 as main effects and interactions. The effect measure was death rate. The protocol was registered in PROSPERO with registration number CRD42023383065. Results: A total of 2,725 COVID-19 patients, consisting of 96 patients with stroke with a temporal precedence of COVID-19 were investigated from three studies. Among the inflammatory biomarkers, only CRP found eligible for pooled analysis. In the interaction model of CRP, significant positive interactions with CRP were found for both groups of stroke and non-stroke (P <0.001), in which the interaction with stroke group was more severe. In the interaction model of D-dimer, a significant positive interaction with D-dimer was found for the stroke group (P <0.001), while the interaction with the non-stroke group was not statistically significant (P =0.158). Conclusion: The present study found the role CRP and D-dimer in prognosis of stroke in patients with COVID-19 as both main effect and interaction modeling. The evidence obtained from these mixed model meta-regression analyses was of moderate quality.