Stroke Occurs Rarely in Critically Ill COVID-19 Patients
Presenter: Jonathon Fanning, BSc, MBBS, PhD
An international registry of critically ill COVID-19 patients found acute stroke was infrequent, occurring in 2.2% of patients. Hemorrhagic, but not ischemic, stroke, was associated with significantly increased mortality.
COVID-19 has been implicated in neurological complications and associated with increased morbidity and mortality. Cerebrovascular complications are particularly concerning, with a frequency from 1-6% reported in SARS-CoV-2 positive patients. However, reports have generally been restricted to small patient populations and not specifically focused on the most critically ill patients requiring intensive care unit (ICU) care.
“Stroke has been a known serious complication of COVID-19, with some studies reporting a higher-than-expected occurrence, especially in young people. However, among the sickest of patients, those admitted to an ICU, our research found that stroke was not a common complication and that a stroke from a blood clot did not increase the risk of death,” said Jonathon Fanning, MBBS, PhD, of the University of Queensland in Brisbane, Australia.
The COVID-19 Critical Care Consortium, a global alliance of clinicians and scientists committed to using groundbreaking technology to identify the most effective treatments for the most critically ill patients in the COVID-19 pandemic, set out to determine the frequency, types, and outcomes of stroke occurring as a complication of COVID-19 requiring ICU admission. A prospective registry of COVID-19 patients admitted to ICUs in more than 370 international sites in 52 countries between January 1 and December 21, 2020, identified 2,699 adults, median age 53 years, with clinically suspected or laboratory confirmed active COVID-19 infection. Some 59 patients (2.2%) experienced acute stroke during their ICU stay: 19 patients (32%) ischemic, 27 patients (46%) hemorrhagic, and 13 patients (22%) unspecified. Two-thirds of the patients were men.
A survival model using parametric Weibull regression demonstrated that the probability of having a stroke in the ICU was small, but gradually increased over time. Hemorrhagic stroke greatly increased the cumulative hazard of death (HR = 2.7; 95% Cl: 1.4, 5.3), while ischemic stroke did not (HR = 1.0; 95% Cl: 0.5, 2.4).
Despite a high mortality (72%) in hemorrhagic stroke patients, stroke was the primary cause of death in only 15% of patients, with multi-organ failure the leading cause of death.
“For people with COVID-19 in intensive care, our large study found that stroke was not common, and it was infrequently the cause of death,” said Fanning. “Still, COVID-19 is a new disease and mutations have resulted in new variants, so it’s important to continue to study stroke in people with the disease. More importantly, while the proportion of those with a stroke may not be as high as we initially thought, the severity of the pandemic means the overall absolute number of patients around the world who will suffer a stroke and the ongoing implications of that for years to come, could create a major public health crisis.”
The study has several limitations. It was primarily retrospective, routine stroke surveillance globally is heterogeneous, and unspecified strokes limited the analysis of each subtype, said Fanning.
Jonathon Fanning, BSc, MBBS, PhD has nothing to disclose.