Effects of COVID-19 on Stroke Presentation & Severity Are Globally Verified
In what may be one of the largest collaborations and observational studies conducted to date, data from 6 continents, 70 countries, and 457 stroke centers were analyzed to evaluate incidence in stroke during the first 4 months of and the last 4 months before the COVID-19 pandemic. Diagnoses were identified by ICD-10 codes or stroke center database classifications.
Compared to the 4 months before the COVID-19 pandemic, stroke admissions from March 1 to June 30, 2020 decreased by 11.5% (95%CI, -11.7% to -11.3%, P<.0001) from 91,373 to 80,894. Intravascular therapies for stroke decreased by 13.2% (95% CI, -13.8%--12.7%, P<.0001) from 1,337 to 1,178 during the same period. The decrease was higher in the first 2 months of the pandemic vs the second 2 months. Interfacility transfers for intravenous therapies also decreasd. The incidence of stroke in people hospitalized for COVID-19 was 1.48% and of those admitted for stroke, 3.3% were infected with SARS-CoV-2). Higher declines in the number of people presenting with stroke were associated with primary stroke centers vs comprehensive stroke centers and with the volume of patients hospitalized with COVID-19.
Additionally, a separate, prospective observational study from the COVID-19 Critical Care Consortium showed that among adults with COVID-19 who were hospitalized in an intensive care unit (ICU) during 2020, 2% experienced stroke after they were admitted to the ICU. Hemorrhagic stroke (32%) was associated with a higher risk of death among, but ischemic stroke (46%) was not, and 22% of strokes were not specified as hemorrhagic or ischemic.
The survival model demonstrated that the probability of having a stroke in the ICU was small, but gradually increased over time. Hemorrhagic stroke greatly increased the cumulative hazard of death (HR, 2.7; 95% Cl: 1.4, 5.3), while ischemic stroke did not (HR,1.0; 95% Cl: 0.5, 2.4). Despite high mortality (72%) in patients with hemorrhagic stroke, stroke was the primary cause of death in only 15%, with multiorgan failure the leading cause of death. Survival models utilizing 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. In this registry study, 2,699 eligible patients (median age 53, 55% female) were registered across more than 370 sites in 52 countries.
“Stroke has been a known serious complication of COVID-19 with some studies reporting a higher-than-expected occurrence, especially in young people,” said Jonathon Fanning, MBBS, PhD, University of Queensland. “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. 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. 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.”
These data were presented at the virtual 2021 American Academy of Neurology (AAN) Virtual Annual Meeting April 17-22, 2021.