Abstract Details

COVID-19 has been implicated in the occurrence of neurological complications and associated increased morbidity and mortality. Cerebrovascular complications are particularly concerning, with a frequency from 1-6% reported in SARS-CoV-2 positive patients. However, such reports have generally been restricted to small patient populations and not specifically focussed on the most critically-ill patients requiring ICU care.

To determine the frequency, types and outcomes of stroke occurring as a complication of coronavirus disease 2019 (COVID-19) requiring intensive care unit (ICU) admission for acute respiratory distress syndrome (ARDS).

The COVID-19 Critical Care Consortium (CCCC) is a prospective observational study enrolling patients over 18 requiring ICU admission for SARS-CoV-2 infection. Patients sustaining imaging-confirmed cerebrovascular events post ICU admission from January 1^st through December 21^st, 2020 were included in analysis. Survival models utilising parametric Weibull regression were used to investigate the impact of stroke on ICU death and discharge rates. These results were confirmed using semi-parametric Cox models.

2,715 eligible patients (median age=53, male=65%) were registered across more than 370 sites spanning 52 countries. Of these, 59 (2.2%) patients experienced acute stroke during their ICU stay: 19 (32%) ischemic, 27 (46%) haemorrhagic, and 13 (22%) unspecified. Haemorrhagic stroke greatly increased the cumulative hazard of death (HR=4.99; 95% CI: 2.62, 9.52), while ischemic stroke did not (HR = 1.01; 95% CI: 0.43, 2.40). Despite high mortality (72%) in patients with haemorrhagic stroke, stroke was the primary cause of death in only 15%, with multiorgan failure the leading cause of death. The survival model demonstrated that the probability of having a stroke in the ICU was small, but gradually increased over time.

In an international registry of critically-ill COVID-19 patients, acute stroke was infrequent – occurring in just 2.2% of patients. Haemorrhagic, but not ischaemic stroke, was associated with significantly-increased mortality.