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Meta-Analysis
. 2021 Feb 15:149:e66.
doi: 10.1017/S0950268821000376.

Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

Ya Gao  1   2 , Yamin Chen  1   2 , Ming Liu  1   2 , Mingming Niu  1   2 , Ziwei Song  1   2 , Meili Yan  1   2 , Jinhui Tian  1   3
Affiliations
Meta-Analysis

Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

Ya Gao et al. Epidemiol Infect. .

Abstract

Coronavirus disease 2019 (COVID-19) has become a global pandemic. Previous studies showed that comorbidities in patients with COVID-19 are risk factors for adverse outcomes. This study aimed to clarify the association between nervous system diseases and severity or mortality in patients with COVID-19. We performed a systematic literature search of four electronic databases and included studies reporting the prevalence of nervous system diseases in COVID-19 patients with severe and non-severe disease or among survivors and non-survivors. The included studies were pooled into a meta-analysis to calculate the odds ratio (OR) with 95% confidence intervals (95%CI). We included 69 studies involving 17 879 patients. The nervous system diseases were associated with COVID-19 severity (OR = 3.19, 95%CI: 2.37 to 4.30, P < 0.001) and mortality (OR = 3.75, 95%CI: 2.68 to 5.25, P < 0.001). Specifically, compared with the patients without cerebrovascular disease, patients with cerebrovascular disease infected with COVID-19 had a higher risk of severity (OR = 3.10, 95%CI: 2.21 to 4.36, P < 0.001) and mortality (OR = 3.45, 95% CI: 2.46 to 4.84, P < 0.001). Stroke was associated with severe COVID-19 disease (OR = 1.95, 95%CI: 1.11 to 3.42, P = 0.020). No significant differences were found for the prevalence of epilepsy (OR = 1.00, 95%CI: 0.42 to 2.35, P = 0.994) and dementia (OR = 2.39, 95%CI: 0.55 to 10.48, P = 0.247) between non-severe and severe COVID-19 patients. There was no significant association between stroke (OR = 1.79, 95%CI: 0.76 to 4.23, P = 0.185), epilepsy (OR = 2.08, 95%CI: 0.08 to 50.91, P = 0.654) and COVID-19 mortality. In conclusion, nervous system diseases and cerebrovascular disease were associated with severity and mortality of patients with COVID-19. There might be confounding factors that influence the relationship between nervous system diseases and COVID-19 severity as well as mortality.

Keywords: COVID-19; Cerebrovascular disease; meta-analysis; mortality; nervous system disease; severe illness.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1.
Fig. 1.
The flowchart of the screening process.
Fig. 2.
Fig. 2.
Association between nervous system diseases and the severity of COVID-19.
Fig. 3.
Fig. 3.
Association between nervous system diseases and the mortality of COVID-19.
Fig. 4.
Fig. 4.
Association between cerebrovascular disease and the severity of COVID-19.
Fig. 5.
Fig. 5.
Association between cerebrovascular disease and the mortality of COVID-19.
Fig. 6.
Fig. 6.
Association between (a) stroke, (b) epilepsy, (c) dementia and the severity of COVID-19.
Fig. 7.
Fig. 7.
Association between (a) stroke and (b) epilepsy and the mortality of COVID-19.
See this image and copyright information in PMC

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