Objective

To determine whether a history of cerebrovascular disease (CVD) increases risk of severe coronavirus disease 2019 (COVID-19).

Methods

In 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.

Results

Pooled 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).

Conclusion

A 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.

中文翻译：

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脑血管病史与COVID-19严重程度的关联。

目的

确定脑血管病（CVD）的病史是否会增加严重冠状病毒病2019（COVID-19）的风险。

方法

在一项回顾性多中心研究中，我们从2020年3月1日至2020年4月15日在德国萨克森州三家医院的COVID-19注册表中检索了住院患者的个人数据。我们还根据PRISMA的建议，使用PubMed，EMBASE，Cochrane图书馆数据库和已鉴定论文的书目进行了系统的审查和荟萃分析（最后检索于2020年4月11日），并将数据与来自我们多中心研究的数据合并在一起。在鉴定的3762条记录中，11项合格的实验室确认的COVID-19患者的观察性研究纳入了定量数据合成。

使用DerSimonian和Laird随机效应模型汇总了根据CVD历史记录的严重COVID-19的风险比（RR）。使用Cochran的Q和I2统计量评估研究之间的异质性。根据纳入研究中使用的定义，COVID-19的严重程度是主要结果。对具有相同严重性定义的一组研究进行了敏感性分析。

结果

汇总分析包括来自1906年实验室确认的COVID-19患者的数据（女性为43.9％，中位年龄为39至76岁）。既往有CVD的患者发生严重COVID-19的风险要高于没有[RR 2.07，95％置信区间（CI）1.52–2.81的患者；p  <0.0001]。在通过临床参数（RR 1.44，95％CI 1.22–1.71；p  <0.0001），重症监护的必要性（RR 2.79，95％CI 1.83–4.24；需要重症监护）定义疾病严重表现的研究中，也观察到了这种关联。p  <0.0001）和院内死亡（RR 2.18，95％CI 1.75–2.7；p  <0.0001）。

结论

CVD的病史可能构成COVID-19临床病程不利的重要危险因素，提示需要针对此高危人群制定专门的感染预防和临床管理策略。