Intracerebral haemorrhage only slightly increases mortality in COVID-19 patients

An Italian study addressing the clinical course of patients with intracerebral haemorrhage (ICH) and simultaneous SARS-CoV-2 infection confirmed that age, ICH location, and previous antiplatelet or anticoagulant treatment predict in-hospital death. Unlike ischaemic stroke, ICH in COVID-19 patients only slightly increased mortality.

The study, presented by Dr Davide Sangalli (Alessandro Manzoni Hospital, Italy), was initiated by the Italian Society of Hospital Neurosciences (SNO) as a retrospective, observational study in 20 Northern Italian medical centres [1]. Included were 949 consecutive patients admitted to neurological departments from 1 March to 30 April 2020 with cerebrovascular disease. Average age was 73.4 years, 52.7% were men. A total of 127 patients (13.4%) had primary ICH, 68 (53.5%) of whom were women. Only 16 ICH patients (12.6%) had laboratory-confirmed SARS-CoV-2 infection. There were no gender differences.

During hospitalisation, 32 patients (25.2%) died; 6 were SARS-CoV-2-positive (37.5%), 26 were negative (23.4%); the difference was not statistically significant (OR 1.96; 95% CI 0.65–5.91; P=0.20). The need for respiratory support negatively affected prognosis: 8 patients required continuous positive airway pressure (CPAP), 7 were eventually intubated. Most deaths in COVID-19 patients occurred in the severe pneumonia and respiratory distress group: 4 of 7 died (57.2%), while only 2 of 9 patients (22%) in the group with no or mild COVID-19 symptoms died (OR 4.4; 95% CI 0.9–20.8; P=0.06).

SARS-CoV-2-related pneumonia or respiratory distress, lobar location, and previous antiplatelet or anticoagulant treatment were the only factors significantly associated with increased mortality in ICH. SARS-CoV-2 infection, regardless of respiratory involvement, led to a non-significantly increased risk of in-hospital death, which was not as marked as that observed in ischaemic stroke or myocardial infarction. In this cohort, a massive inflammatory response with increased CRP values appeared to be related with a worse prognosis in SARS-CoV-2 patients, whereas elevated D-dimer levels increased mortality risk in both SARS-CoV-2-positive and -negative patients.

1. Sangalli D, et al. Primary intracerebral haemorrhage during SARS-CoV-2 outbreak. OPR-143, EAN 2021 Virtual Congress, 19–22 June 2021.

 

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Posted on 18 August 202129 February 2024