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Stroke uncommon in critically ill COVID-19 patients

Presented by
Dr Jonathon Fanning, University of Queensland, Australia
AAN 2021
In a large, year-long study, stroke was an infrequent complication in critically ill patients admitted to an intensive care unit (ICU) with COVID-19. Of 2,699 patients registered across more than 370 sites spanning 52 countries, 59 (2.2%) experienced acute stroke during their ICU stay. In these patients, haemorrhagic stroke was associated with a higher risk of death, but not ischaemic stroke.

Cerebrovascular complications of COVID-19 occur in 1-6% of COVID-19 patients. The incidence of stroke seems higher than expected, especially in younger patients. The COVID-19 Critical Care Consortium (CCCC) is a prospective observational study that focuses on critically ill patients requiring admission to the ICU [1]. The study selected 2,699 eligible patients registered across over 370 sites in 52 countries. Median age was 53 years, 65% were male.

During their ICU stay, 59 patients (2.2%) experienced an acute stroke. Of these, 19 (32%) were ischaemic, 27 (46%) haemorrhagic, and 13 (22%) unspecified. Haemorrhagic stroke increased the cumulative hazard of death (HR 2.7; 95% CI 1.4–5.3), while ischaemic stroke did not (HR 1.0; 95% CI 0.5–2.4). Of patients with haemorrhagic stroke, 72% died. However, only 15% of these died of stroke, with multiorgan failure being 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 leading author Dr Jonathon Fanning (University of Queensland, Australia). “Still, COVID-19 is a new disease and mutations have resulted in new variants, so it is 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.”

  1. Fanning J, et al. Stroke complicating critically ill patients with SARS-CoV-2: Analysis of the COVID-19 Critical Care Consortium (CCCC) international, multicenter observational study. AAN 2021 Virtual Congress, 17-22 April.

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