Abstract Details

Title Sex Differences on Cerebrovascular Complications in Hospitalized COVID-19 Patients: A Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-030

Objective We aimed to investigate whether sex differences impact risk of development of ischemic(IS) and hemorrhagic stroke(HS) among hospitalized COVID-19 patients.

Background Risk of vascular events is associated with Coronavirus Disease 19(COVID-19) with variable rate of acute stroke. Data indicate that COVID-19-related stroke disproportionately affects males. Pre-pandemic studies show that stroke is higher among females. Whether these data reflect underlying sex-specific biological differences, recruitment biases, or confounding factors is unclear.

Design/Methods Systematic search of MEDLINE(PubMed) and six other databases was done from inception to April 2023. Studies were included if they enrolled both hospitalized adult males and females with active COVID-19 disease and reported prevalence of stroke with sex stratification. Composite stroke included earliest hospital admission with stroke occurrence or death with stroke as underlying cause. We define risk ratio as the cumulative incidence of type of stroke in males over the cumulative incidence of the same stroke in females.

Results

We included 19 studies encompassing 135,892 patients(median age=63 years,48.7% males), of which 1,585(1.2%) had a stroke with IS being the most common(53.4%,n=841/1,585), followed by unspecified stroke(29.7%,n=471/1,585), and HS(17.3%,n=274/1,585).

We found that there is higher proportion of males(17%;95%CI = 15%-19%) than females(8%;CI=7%-10%) who developed composite stroke. There was also two-fold greater proportion of males(18%; 95%CI=15%-20%) having IS than females(9%;CI=7%-11%). Males(5%;CI=3%-7%) also had higher risk of HS compared to females(1%;CI=0%-2%). Lastly, we find that males(2%;95%CI=0%-3%) and females(2%;95%CI=0%-3%) have equal proportions of having unspecified stroke.

Overall, males had an increased risk of developing composite stroke compared to females(RR=1.26;95%CI=1.07-1.48). Males also had a higher risk of HS compared to female(RR=1.65;95%CI=1.232.21). The risk of developing IS was similar between the groups(RR=1.15;95%CI=0.98-1.35).

Conclusions Males had higher proportion of developing stroke. Males also had increased risk of acute stroke during COVID-19 hospitalization, especially hemorrhagic strokes. Further studies are needed on the mechanism of male sex and stroke among hospitalized COVID-19 individuals.

Authors/Disclosures
Bradley G. Ong, MD (Cleveland Clinic Main Campus - Neurological Institute) PRESENTER	The institution of Dr. Ong has received research support from American Academy of Neurology. The institution of Dr. Ong has received research support from American Headache Society. Dr. Ong has received personal compensation in the range of $0-$499 for serving as a Expert Witness with Chandler Advocacy. Dr. Ong has a non-compensated relationship as a Editorial Board Member with Neurology Resident & Fellow Section that is relevant to AAN interests or activities. Dr. Ong has a non-compensated relationship as a Contributor with Neurology Minute that is relevant to AAN interests or activities.
Lea Elora A. Conda, MD, MBA (Philippine Institute for Developmental Studies)	Dr. Conda has nothing to disclose.
Ken Uchino, MD (Cleveland Clinic Foundation)	Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aboott Laboratories, Inc.. Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ACP JOURNAL CLUB. The institution of Dr. Uchino has received research support from NIH.
Tereynz Paul Mendoza	No disclosure on file
Adrian V. Hernandez (University of Connecticut)	No disclosure on file
Sung-Min Cho, DO (Johns Hopkins Hospital)	Dr. Cho has nothing to disclose.