Observational study: prospective longitudinal cohort (Green)
In this study recently published in the European Journal of Neurology, the authors aimed to define the risk of acute stroke in patients with severe and non‐severe COVID‐19. They performed an observational multicentre cohort study in four participating hospitals in Saxony, Germany to characterise consecutive patients with laboratory‐confirmed COVID‐19 who experienced acute stroke during hospitalisation. Furthermore, they conducted a systematic review using PubMed/MEDLINE, EMBASE, Cochrane Library and bibliographies of identified papers following PRISMA guidelines including data from observational studies of acute stroke in COVID‐19 patients. Data was extracted by two independent reviewers and pooled with multicentre data to calculate risk ratios (RR) and 95% confidence intervals (95%CIs) for acute stroke related to COVID‐19 severity using random effects models. Between‐study heterogeneity was assessed using Cochran’s Q and I2‐statistics. Of 165 patients hospitalised for COVID‐19 (49.1% males, median age 67 years [57‐79], 72.1% severe or critical condition) included in the multicentre study, overall stroke rate was 4.2% (95%CI: 1.9‐8.7%). The systematic literature search identified two observational studies involving 576 patients that were eligible for meta‐analysis. Among 741 pooled COVID‐19 patients, overall stroke rate was 2.9% (95%CI: 1.9‐4.5). The risk of acute stroke was increased for patients with severe compared to non‐severe COVID‐19 (RR 4.18, 95%CI 1.7‐10.25; p=0.002) with no evidence of heterogeneity (I2=0%, p=0.82). The authors concluded that synthesised analysis of data from their multicentre study and previously published cohorts indicate that severity of COVID‐19 is associated with an increased risk of acute stroke.