Stroke occurs infrequently in large cohort study of patients hospitalized with COVID-19

Acute stroke occurred rarely in a cohort of nearly 2,700 “critically ill” patients with COVID-19, according to findings from an international registry that also demonstrated greater mortality with hemorrhagic, but not ischemic, stroke.

Study results showed that 59 of the 2,699 patients with COVID-19 (2.2%) had an acute stroke during their ICU admission. The researchers presented their findings at the American Academy of Neurology annual meeting, which is being held virtually.

“Stroke has been a known serious complication of COVID-19 with some studies reporting a higher-than-expected occurrence, especially in young people,” study author Jonathon Fanning, BSc, MBBS, PhD, FANZCA, FCICM, of the University of Queensland in Brisbane, Australia, and a member of the American Academy of Neurology, said in a press release. “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.”

Fanning and colleagues analyzed the rate of stroke occurring as a complication of COVID-19 infection that required ICU admission, as well as the types of stroke and related outcomes. They specifically looked at the impact of stroke on ICU death and discharge rates. Patient data came from the COVID-19 Critical Care Consortium, a prospective, observational study that comprised patients aged older than 18 years who required ICU admission due to COVID-19. The analysis included patients diagnosed with acute stroke after ICU admission between January 1, 2020, and December 21, 2020.

The researchers registered 2,699 patients from more than 370 sites in 52 countries. The study comprised mostly men (65%) and the median age of patients was 53 years.

Of these patients, 59 (2.2%) experienced an acute stroke during their ICU stay, including 19 patients who had an ischemic stroke (32%) and 27 patients who had a hemorrhagic stroke (46%). The type of stroke was unspecified in 13 patients (22%), according to the study results.

A survival model showed that the chance for having a stroke in the ICU was small, however this likelihood increased over time. Fanning and colleagues found that hemorrhagic stroke “greatly increased” the cumulative hazard for death (HR = 2.7; 95% CI, 1.4-5.3), while ischemic stroke did not (HR = 1; 95% CI, 0.5-2.4).

The researchers observed high mortality in patients who had a hemorrhagic stroke (72%), but stroke was the primary cause of death in only 15% of patients. Multiorgan failure represented the leading cause of death, according to the study results.

“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,” Fanning said in the press release. “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.”