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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Intracerebral Hemorrhage and Coronavirus Disease 2019 in a Cohort of 282,718 Hospitalized Patients
Adnan I Qureshi1, William I Baskett2, Wei Huang1
1Zeenat Qureshi Stroke Insititutes and Department of Neurology, University of Missouri, One Hospital Dr. CE507, Columbia, MO, USA.
Insights
The risk of intracerebral hemorrhage is not higher in patients with coronavirus disease 2019 (COVID-19). However, COVID-19 patients with intracerebral hemorrhage face higher mortality due to increased comorbidities and adverse events.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Investigating the association between coronavirus disease 2019 (COVID-19) and intracerebral hemorrhage (ICH) risk.
- Comparing risk factors, comorbidities, and outcomes in patients with both ICH and COVID-19 versus those without COVID-19.
Purpose of the Study:
- To determine if COVID-19 increases the risk of intracerebral hemorrhage.
- To analyze the impact of COVID-19 on outcomes for patients experiencing intracerebral hemorrhage.
Main Methods:
- Utilized the Cerner deidentified COVID-19 data set from 62 healthcare facilities.
- Included patients with emergency department or inpatient encounters related to COVID-19 (suspected, exposed, or confirmed).
- Compared incidence of ICH and associated outcomes between COVID-19 positive and negative patient cohorts.
Main Results:
- A lower risk of intracerebral hemorrhage was observed in patients with COVID-19 (OR 0.5; 95% CI 0.5-0.6; p < .0001) after multivariate adjustment.
- Patients with both ICH and COVID-19 had significantly higher rates of pneumonia, acute kidney injury, acute myocardial infarction, sepsis, and respiratory failure.
- In-hospital mortality was substantially higher for patients with ICH and COVID-19 (40.3%) compared to those without COVID-19 (19.0%).
Conclusions:
- The study does not indicate an elevated risk of intracerebral hemorrhage in patients with COVID-19.
- Higher mortality in COVID-19 patients with ICH is likely attributed to a greater frequency of comorbidities and adverse in-hospital events.
Background:
To identify whether the risk of intracerebral hemorrhage is higher in patients with coronavirus disease 2019 (COVID-19), we compared the risk factors, comorbidities, and outcomes in patients intracerebral hemorrhage and COVID-19 and those without COVID-19.
Methods:
We analyzed the data from the Cerner deidentified COVID-19 data set derived from 62 health care facilities. The data set included patients with an emergency department or inpatient encounter with discharge diagnoses codes that could be associated with suspicion of or exposure to COVID-19 or confirmed COVID-19.
Results:
There were a total of 154 (0.2%) and 667 (0.3%) patients with intracerebral hemorrhage among 85,645 patients with COVID-19 and 197,073 patients without COVID-19, respectively. In the multivariate model, there was a lower risk of intracerebral hemorrhage in patients with COVID-19 (odds ratio 0.5; 95% confidence interval 0.5-0.6; p < .0001) after adjustment for sex, age strata, race/ethnicity, hypertension, diabetes mellitus, nicotine dependence/tobacco use, hyperlipidemia, atrial fibrillation, congestive heart failure, long-term anticoagulant use, and alcohol abuse. The proportions of patients who developed pneumonia (58.4% versus 22.5%; p < .0001), acute kidney injury (48.7% versus 31.0%; p < .0001), acute myocardial infarction (11% versus 6.4%; p = .048), sepsis (41.6% versus 22.5%; p < .0001), and respiratory failure (61.7% versus 42.3%; p < .0001) were significantly higher among patients with intracerebral hemorrhage and COVID-19 compared with those without COVID-19. The in-hospital mortality among patients with intracerebral hemorrhage and COVID-19 was significantly higher compared with that among those without COVID-19 (40.3% versus 19.0%; p < .0001).
Conclusions:
Our analysis does not suggest that rates of intracerebral hemorrhage are higher in patients with COVID-19. The higher mortality in patients with intracerebral hemorrhage and COVID-19 compared with those without COVID-19 is likely mediated by higher frequency of comorbidities and adverse in-hospital events.
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