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About 2% of COVID-19 patients experienced a stroke after they were admitted to intensive care, a year-long, multinational study showed.

Of these ICU patients, hemorrhagic stroke was linked to higher mortality, but ischemic stroke was not, reported Jonathon Fanning, MBBS, PhD, of the University of Queensland in Brisbane, Australia, in an abstract released in advance of the American Academy of Neurology annual meeting. The findings will be presented as part of the meeting's on April 18.

"Stroke has been a known serious complication of COVID-19, with some studies reporting a higher-than-expected occurrence, especially in young people," Fanning said in a statement. "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."

The findings were based on the observational study, a database of patients admitted to ICUs in 52 countries with laboratory-confirmed or clinically suspected SARS-CoV-2 infection from Jan. 1 through Dec. 21, 2020. Across 370 sites, 2,699 patients were included in the analysis. Median age was 53, and 65% of participants were men.

Of these patients, 59 (2.2%) experienced acute stroke during their ICU stay: 19 (32%) were ischemic, 27 (46%) were hemorrhagic, and 13 (22%) were unspecified. A survival model using parametric Weibull regression showed that the probability of having a stroke in the ICU was small, but increased gradually over time.

Hemorrhagic stroke significantly increased the cumulative hazard of death (HR 2.7, 95% CI 1.4-5.3), but ischemic stroke did not (HR 1.0, 95% CI 0.5-2.4). Nearly three of four COVID-19 patients (72%) who developed hemorrhagic stroke in the ICU died, but stroke was the primary cause of death in only 15% of stroke patients, with multiorgan failure as the leading cause.

In other COVID-19 patients, stroke risk is emerging to be lower than previously thought. An analysis presented in March showed that ischemic stroke incidence among hospitalized patients in the American Heart Association COVID-19 Registry was 0.75% overall, lower than the 0.9% to 2% reported in other studies.

"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," Fanning said. "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," he added.

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