Dr Jonathon Fanning

Stroke is less common then previously thought in people with severe COVID-19 and is rarely a cause of death, Australian-led  research shows.

With reports of cerebrovascular complications affecting up to 6% of people with COVID-19, researchers led by  Dr Jon Fanning and colleagues at the University of Queensland Critical Care Research Group investigated outcomes from an international registry with data for 2,699 people who were admitted to an ICU for management of severe COVID-19 infection throughout 2020.

Overall 59 (2.2%) patients experienced acute stroke during their ICU stay, of which 19 (32%) were ischaemic, 27 (46%) haemorrhagic stroke, and 13 (22%) unspecified.

Presenting the findings at the American Academy of Neurology (AAN) virtual Annual Meeting Dr Fanning noted that haemorrhagic stroke  was associated with a three fold increased cumulative hazard of death (Hazard Ratio=2.7; 95% Cl: 1.4, 5.3), while ischaemic stroke did not increase mortality (HR= 1.0; 95% Cl: 0.5, 2.4).

And despite high mortality (72%) in patients with haemorrhagic stroke, stroke was the primary cause of death in only 15% of cases, with multiorgan failure being the leading cause of death.

Dr Fanning said the registry data showed that the overall probability of having a stroke in the ICU was small, but gradually increased over time.

“Stroke has been a known serious complication of COVID-19 with some studies reporting a higher-than-expected occurrence, especially in young people,” he told the AAN meeting.

“However, among the sickest of patients, those admitted to an ICU, our research found that stroke was not a common complication and that a [ischaemic] stroke … did not increase the risk 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 Dr Fanning.

However, since COVID-19 is a novel and evolving disease with several new variants, it will be important to continue to study stroke outcomes in people with the disease, he added.

“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 data, from the COVID-19 Critical Care Consortium (CCCC) were derived from COVID-19 patients managed in ICUs in 52 countries, with an average age of 53.