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Published on: October 15, 2021
A Longitudinal Research on the Distribution and Prognosis of Intracerebral Hemorrhage During the COVID-19 Pandemic
Gangqiang Lin1, Xueqian Xu1, Xiaoqian Luan1
1Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Insights
The COVID-19 pandemic reduced intracerebral hemorrhage (ICH) admissions, leading to higher mortality and disability. Ensuring timely treatment and adequate resources is crucial for patients with ICH.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Intracerebral hemorrhage (ICH) is a significant global cerebrovascular disease.
- The COVID-19 pandemic disrupted medical resource allocation and patient care starting in 2020.
- Understanding the impact of the pandemic on ICH patient characteristics and outcomes is critical.
Purpose of the Study:
- To determine the characteristics and prognoses of intracerebral hemorrhage patients during the COVID-19 pandemic.
- To identify factors associated with poor outcomes and mortality in ICH patients during the pandemic.
Main Methods:
- Comparative analysis of ICH patients diagnosed between January-June 2020 and January-June 2019.
- Exclusion of COVID-19 positive patients.
- 30-day survival analysis and regression modeling to identify determinants of poor outcomes (modified Rankin score 3-6) and death.
Main Results:
- A slight decrease in ICH diagnoses in 2020 compared to 2019, with a 35.1% drop in admissions during February 2020 lockdown.
- Significant differences in patient domicile distribution and baseline modified Rankin score between the two years.
- Higher 30-day mortality in February 2020 (29.4%) versus February 2019 (19.8%).
- Age, baseline mRS, postoperative complications, massive brainstem hemorrhage, and creatinine were significant predictors of poor outcomes and death.
Conclusions:
- The COVID-19 pandemic lockdown led to decreased ICH admissions and increased severity at presentation, resulting in higher mortality and disability.
- Effective "green channels" and adequate medical resource allocation are essential for timely ICH patient treatment and neurosurgery.
Purpose:
Globally, intracerebral hemorrhage (ICH) is a common cerebrovascular disease. At the beginning of 2020, due to the coronavirus disease 2019 (COVID-19) pandemic, the allocation of medical resources and the patient treatment and referrals were affected to varying degrees. We aimed to determine the characteristics and prognoses and associated factors of patients with ICH.
Patients And Methods:
The baseline demographic characteristics and ICH outcomes were compared between patients diagnosed with ICH between January and June 2020 (the 2020 group) and between January and June 2019 (the 2019 group). COVID-19 positive patients were excluded from the study. A 30-day data from patients in the 2019 and 2020 groups were analyzed to create survival curves for these patients. We also used regression models to identify the significant determinants of poor outcomes [modified Rankin score (mRS): 3-6] and death.
Results:
The number of patients diagnosed with ICH was slightly lower in the 2020 group (n = 707) than in the 2019 group (n = 719). During the lockdown period (February 2020), the admission rates for ICH decreased greatly by 35.1%. The distribution of the patients' domicile (P = 0.002) and the mRS (P < 0.001) differed significantly between the years. The survival curve revealed that the highest risk of death was in the acute stage (especially in the first 5 days) of ICH. At 30 days, mortality was 19.8% in February 2019 and 29.4% in February 2020 (P = 0.119). Multivariate analysis revealed age, baseline mRS, postoperative complications, massive brainstem hemorrhage, and creatinine as factors significantly associated with poor outcomes and death following ICH. Neurosurgery and massive supratentorial hemorrhage were only correlated with the risk of death.
Conclusion:
During the lockdown period, the COVID-19 pandemic caused a decrease in the admission rates and severe conditions at admission due to strict traffic constraints for infection control. This led to high mortality and disability in patients with ICH. It is necessary to ensure an effective green channel and allocate adequate medical resources for patients to receive timely treatment and neurosurgery.
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