Risk of Stroke in Patients with Herpes Zoster: A Systematic Review and Meta-Analysis.
BACKGROUND
Several observational studies suggest that herpes zoster (HZ) may increase the risk of stroke, but the results are inconsistent. Our study was designed to assess the association between HZ and the risk of stroke through a meta-analysis of cohort studies.


METHODS
The electronic databases PubMed and EMBASE were searched from inception to May 31, 2016 to identify relevant cohort studies that assess the risk of stroke in patients with HZ. Reference lists were also reviewed to identify potential studies. The random-effects model and fixed-effects model were used to calculate the summary relative risks (RRs) with 95% confidence intervals (CIs).


RESULTS
Six cohort studies (251,076 HZ patients and 8462 cases of stroke) were identified in the study. The result showed that HZ was significantly correlated with increased risk of stroke, and the pooled RR was 1.36 (95% confidence interval [CI]: 1.10, 1.67) (P = .004). In the subgroup analysis, the significant association was observed except for stroke type (hemorrhage group). In the sensitivity analysis, excluding 1 study, the pooled RR was 1.45 (95% CI: 1.17, 1.80) (P = .001) for HZ, and 4.42 (95% CI: 2.75, 7.11) (P = .000) for herpes zoster ophthalmicus. Considerable heterogeneity was observed in our study.


CONCLUSIONS
Our study furnishes evidence of a positive association between HZ and the risk of stroke.
Department of Dermatology, Shengli Oilfield Central Hospital, 31 Jinan Road, Dongying, Shandong 257000, China.
Sheng-Ye
SY
Yang
Department of Neurosurgery, Shengli Oilfield Central Hospital, 31 Jinan Road, Dongying, Shandong 257000, China.
Hong-Xing
HX
Li
Department of Central Laboratory, Shengli Oilfield Central Hospital, 31 Jinan Road, Dongying, Shandong 257000, China.
Xin-Hao
XH
Yi
Department of Neurosurgery, Shengli Oilfield Central Hospital, 31 Jinan Road, Dongying, Shandong 257000, China.
Guang-Liang
GL
Han
Department of Neurosurgery, Shengli Oilfield Central Hospital, 31 Jinan Road, Dongying, Shandong 257000, China.
Qiang
Q
Zong
Department of Neurosurgery, Shengli Oilfield Central Hospital, 31 Jinan Road, Dongying, Shandong 257000, China.
Ming-Xing
MX
Wang
Department of Intensive Care Unit (ICU), Shengli Oilfield Central Hospital, 31 Jinan Road, Dongying, Shandong 257000, China. Electronic address: luckpxx@sina.com.
Xiao-Xiao
XX
Peng
D006562:Herpes Zoster / Q000453:epidemiology*; D006801:Humans; D012306:Risk; D020521:Stroke / Q000453:epidemiology*
Herpes zoster; meta-analysis; risk factor; stroke