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035 Case-control study of risk factors for stroke among critically-ill patients with SARS-CoV-2: an analysis of the COVID-19 critical care consortium (CCCC) global registry
  1. Jonathon P Fanning1,2,3,
  2. Adrian Barnett4,
  3. Glenn Whitman5,
  4. Rakesh Arora6,
  5. Lavien Premraj7,
  6. Denise Battaglini8,
  7. Sam Huth1,2,
  8. Diego Bastos Porto9,
  9. Huimahn Choi10,
  10. Jacky Suen1,2,
  11. Gianluigi Li Bassi1,2,11,
  12. John Fraser1,2,12,
  13. Matthew Griffee13,
  14. Chiara Robba8 and
  15. Sung-Min Cho14
  1. 1Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
  2. 2Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
  3. 3Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
  4. 4Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, , Queensland University of Technology, Brisbane, QLD, Australia
  5. 5Cardiac Intensive Care Services, Johns Hopkins Hospital and University, Baltimore, MA, USA
  6. 6Cardiac Sciences Program, St. Boniface General Hospital Research Centre, Winnipeg, Manitoba, Canada
  7. 7Griffith University, Gold Coast, QLD, Australia
  8. 8San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa, Italy
  9. 9Hospital Sao Camilo de Esteio, Tamandaré, Esteio, Brazil
  10. 10University of Texas Health Sciences Center, Houston, Texas, USA
  11. 11Institut d’Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
  12. 12St. Andrew’s War Memorial Hospital, Brisbane, QLD, Australia
  13. 13Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
  14. 14Neurosciences Critical Care Division, Departments of Neurology, Neurosurgery and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MA, USA


Objective COVID-19 has been identified as a risk factor for severe cerebrovascular complications, albeit mostly in small patient populations, limited to specific regions, and including all severities of disease. Utilising the largest database of critically-ill COVID-19 patients, we investigated risk factors for stroke in intensive care unit (ICU) COVID-19 patients.

Methods Data for this matched case-control study were extracted from a large international registry of adult COVID-19 patients requiring ICU admission. Patients with imaging-confirmed cerebrovascular events identified following ICU admission were compared against five controls per case, matched for demographics, morphometrics, illness severity, and ICU days. Expert consensus determined key clinical and laboratory variables for risk assessment.

Results From January 1-December 21 2020, 2,715 ICU patients were registered across >370 sites spanning 52 countries; acute stroke was identified during the ICU stay in 59(2.2%); 27(46%) haemorrhagic, 19(32%) ischaemic, 13(22%) unspecified. Stroke patients had higher SOFA and APACHE scores, more frequent hypertension and cardiovascular disease, and more often required mechanical ventilation, vasopressors, and ECMO. Diabetes, hypertension, smoking, and Caucasian ethnicity were identified as risk factors for ischaemic versus haemorrhagic stroke and being stroke-free. Ethnicity (Hispanic or black), higher PaO2, and extracorporeal membrane oxygenation (ECMO) were significant risk factors for haemorrhagic stroke.Anticoagulation had no association with either stroke subtype.

Conclusions Severe illness and more aggressive management were major risk factors for acute stroke. Traditional vascular risk factors and Caucasian ethnicity were risk factors for ischaemic stroke, while Hispanic or black ethnicity, higher PaO2, and ECMO were significant risk factors for haemorrhagic stroke.

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