Sung-Min Cho1, Lavienraj Premraj, Jonathon Fanning, Samuel Huth, Adrian Barnett, Glenn Whitman, Rakesh C Arora, Denise Battaglini, Diego Bastos Porto, HuiMahn Choi, Jacky Suen, Gianluigi Li Bassi, John F Fraser, Chiara Robba, Matthew Griffee. 1. Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Griffith University School of Medicine, Gold Coast, Qld, Australia. Critical Care Research Group, The Prince Charles Hospital, Brisbane, Qld, Australia. Faculty of Medicine University of Queensland, Brisbane, Qld, Australia. Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), Brisbane, Qld, Australia. Cardiac Science Program, St Boniface General Hospital Research Centre, Winnipeg, MB, Canada. University of Toronto, Toronto, ON, Canada. University of Manitoba, Winnipeg, MB, Canada. Department of Surgical Science and Integrated Diagnostic, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa, Italy. Department of Medicine, University of Barcelona, Barcelona, Spain. Hospital Sao Camilo de Esteio, Esteio, Brazil. University of Texas Health Sciences Center, Houston, TX. Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain. St Andrew's War Memorial Hospital, UnitingCare, Spring Hill, Qld, Australia. Department of Anesthesiology, University of Utah, Salt Lake City, UT.
Abstract
OBJECTIVES: Stroke has been reported in observational series as a frequent complication of coronavirus disease 2019, but more information is needed regarding stroke prevalence and outcomes. We explored the prevalence and outcomes of acute stroke in an international cohort of patients with coronavirus disease 2019 who required ICU admission. DESIGN: Retrospective analysis of prospectively collected database. SETTING: A registry of coronavirus disease 2019 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with acute stroke during their stay. PATIENTS: Patients older than 18 years old with acute coronavirus disease 2019 infection in ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 2,699 patients identified (median age 59 yr; male 65%), 59 (2.2%) experienced acute stroke: 0.7% ischemic, 1.0% hemorrhagic, and 0.5% unspecified type. Systemic anticoagulant use was not associated with any stroke type. The frequency of diabetes, hypertension, and smoking was higher in patients with ischemic stroke than in stroke-free and hemorrhagic stroke patients. Extracorporeal membrane oxygenation support was more common among patients with hemorrhagic (56%) and ischemic stroke (16%) than in those without stroke (10%). Extracorporeal membrane oxygenation patients had higher cumulative 90-day probabilities of hemorrhagic (relative risk = 10.5) and ischemic stroke (relative risk = 1.7) versus nonextracorporeal membrane oxygenation patients. Hemorrhagic stroke increased the hazard of death (hazard ratio = 2.74), but ischemic stroke did not-similar to the effects of these stroke types seen in noncoronavirus disease 2019 ICU patients. CONCLUSIONS: In an international registry of ICU patients with coronavirus disease 2019, stroke was infrequent. Hemorrhagic stroke, but not ischemic stroke, was associated with increased mortality. Further, both hemorrhagic stroke and ischemic stroke were associated with traditional vascular risk factors. Extracorporeal membrane oxygenation use was strongly associated with both stroke and death.
OBJECTIVES:Stroke has been reported in observational series as a frequent complication of coronavirus disease 2019, but more information is needed regarding stroke prevalence and outcomes. We explored the prevalence and outcomes of acute stroke in an international cohort of patients with coronavirus disease 2019 who required ICU admission. DESIGN: Retrospective analysis of prospectively collected database. SETTING: A registry of coronavirus disease 2019patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with acute stroke during their stay. PATIENTS: Patients older than 18 years old with acute coronavirus disease2019 infection in ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 2,699 patients identified (median age 59 yr; male 65%), 59 (2.2%) experienced acute stroke: 0.7% ischemic, 1.0% hemorrhagic, and 0.5% unspecified type. Systemic anticoagulant use was not associated with any stroke type. The frequency of diabetes, hypertension, and smoking was higher in patients with ischemic stroke than in stroke-free and hemorrhagic strokepatients. Extracorporeal membrane oxygenation support was more common among patients with hemorrhagic (56%) and ischemic stroke (16%) than in those without stroke (10%). Extracorporeal membrane oxygenation patients had higher cumulative 90-day probabilities of hemorrhagic (relative risk = 10.5) and ischemic stroke (relative risk = 1.7) versus nonextracorporeal membrane oxygenation patients. Hemorrhagic stroke increased the hazard of death (hazard ratio = 2.74), but ischemic stroke did not-similar to the effects of these stroke types seen in noncoronavirus disease 2019 ICU patients. CONCLUSIONS: In an international registry of ICU patients with coronavirus disease 2019, stroke was infrequent. Hemorrhagic stroke, but not ischemic stroke, was associated with increased mortality. Further, both hemorrhagic stroke and ischemic stroke were associated with traditional vascular risk factors. Extracorporeal membrane oxygenation use was strongly associated with both stroke and death.
Authors: Denise Battaglini; Lavienraj Premraj; Samuel Huth; Jonathon Fanning; Glenn Whitman; Rakesh C Arora; Judith Bellapart; Diego Bastos Porto; Fabio Silvio Taccone; Jacky Y Suen; Gianluigi Li Bassi; John F Fraser; Rafael Badenes; Sung-Min Cho; Chiara Robba Journal: Front Neurol Date: 2022-04-14 Impact factor: 4.086
Authors: Tobias Pantel; Kevin Roedl; Dominik Jarczak; Yuanyuan Yu; Daniel Peter Frings; Barbara Sensen; Hans Pinnschmidt; Alexander Bernhardt; Bastian Cheng; Iris Lettow; Manfred Westphal; Patrick Czorlich; Stefan Kluge; Marlene Fischer Journal: J Clin Med Date: 2021-12-22 Impact factor: 4.241
Authors: Anna M Cervantes-Arslanian; Chakradhar Venkata; Pria Anand; Joseph D Burns; Charlene J Ong; Allison M LeMahieu; Phillip J Schulte; Tarun D Singh; Alejandro A Rabinstein; Neha Deo; Vikas Bansal; Karen Boman; Juan Pablo Domecq Garces; Donna Lee Armaignac; Amy B Christie; Roman R Melamed; Yasir Tarabichi; Sreekanth R Cheruku; Ashish K Khanna; Joshua L Denson; Valerie M Banner-Goodspeed; Harry L Anderson; Ognjen Gajic; Vishakha K Kumar; Allan Walkey; Rahul Kashyap Journal: Crit Care Explor Date: 2022-04-25