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Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study*
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 coronaviru...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594524/ https://www.ncbi.nlm.nih.gov/pubmed/34269719 http://dx.doi.org/10.1097/CCM.0000000000005209 |
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author | Cho, Sung-Min Premraj, Lavienraj Fanning, Jonathon Huth, Samuel Barnett, Adrian Whitman, Glenn Arora, Rakesh C. Battaglini, Denise Porto, Diego Bastos Choi, HuiMahn Suen, Jacky Bassi, Gianluigi Li Fraser, John F. Robba, Chiara Griffee, Matthew |
author_facet | Cho, Sung-Min Premraj, Lavienraj Fanning, Jonathon Huth, Samuel Barnett, Adrian Whitman, Glenn Arora, Rakesh C. Battaglini, Denise Porto, Diego Bastos Choi, HuiMahn Suen, Jacky Bassi, Gianluigi Li Fraser, John F. Robba, Chiara Griffee, Matthew |
author_sort | Cho, Sung-Min |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8594524 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-85945242021-11-19 Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study* Cho, Sung-Min Premraj, Lavienraj Fanning, Jonathon Huth, Samuel Barnett, Adrian Whitman, Glenn Arora, Rakesh C. Battaglini, Denise Porto, Diego Bastos Choi, HuiMahn Suen, Jacky Bassi, Gianluigi Li Fraser, John F. Robba, Chiara Griffee, Matthew Crit Care Med Online Clinical Investigations 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. Lippincott Williams & Wilkins 2021-07-28 2021-12 /pmc/articles/PMC8594524/ /pubmed/34269719 http://dx.doi.org/10.1097/CCM.0000000000005209 Text en Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. |
spellingShingle | Online Clinical Investigations Cho, Sung-Min Premraj, Lavienraj Fanning, Jonathon Huth, Samuel Barnett, Adrian Whitman, Glenn Arora, Rakesh C. Battaglini, Denise Porto, Diego Bastos Choi, HuiMahn Suen, Jacky Bassi, Gianluigi Li Fraser, John F. Robba, Chiara Griffee, Matthew Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study* |
title | Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study* |
title_full | Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study* |
title_fullStr | Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study* |
title_full_unstemmed | Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study* |
title_short | Ischemic and Hemorrhagic Stroke Among Critically Ill Patients With Coronavirus Disease 2019: An International Multicenter Coronavirus Disease 2019 Critical Care Consortium Study* |
title_sort | ischemic and hemorrhagic stroke among critically ill patients with coronavirus disease 2019: an international multicenter coronavirus disease 2019 critical care consortium study* |
topic | Online Clinical Investigations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594524/ https://www.ncbi.nlm.nih.gov/pubmed/34269719 http://dx.doi.org/10.1097/CCM.0000000000005209 |
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