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Observational Study
. 2021 Jul 15:426:117479.
doi: 10.1016/j.jns.2021.117479. Epub 2021 May 5.

Impact of SARS-CoV-2 infection on acute intracerebral haemorrhage in northern Italy

Davide Sangalli  1 , Filippo Martinelli-Boneschi  2 , Maurizio Versino  3 , Irene Colombo  4 , Alfonso Ciccone  5 , Simone Beretta  6 , Simona Marcheselli  7 , Riccardo Altavilla  8 , Mauro Roncoroni  9 , Sandro Beretta  10 , Lorenzo Lorusso  11 , Anna Cavallini  12 , Alessandro Prelle  13 , Donata Guidetti  14 , Sara La Gioia  15 , Paola Santalucia  16 , Carla Zanferrari  17 , Giampiero Grampa  18 , Elisabetta D'Adda  19 , Lorenzo Peverelli  20 , Antonio Colombo  21 , Andrea Salmaggi  22 ; SNO-COVID-19 group
Affiliations
Observational Study

Impact of SARS-CoV-2 infection on acute intracerebral haemorrhage in northern Italy

Davide Sangalli et al. J Neurol Sci. .

Abstract

Introduction: Growing evidence has been published as to the impact of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) on cerebrovascular events over the last few months, with considerable attention paid to ischemic strokes. Conversely, little is known about the clinical course of intracerebral haemorrhage (ICH) and simultaneous SARS-CoV-2 infection.

Method: The Italian Society of Hospital Neurosciences (SNO) promoted a multicentre, retrospective, observational study (SNO-COVID-19), involving 20 Neurological Departments in Northern Italy. Clinical data on patients with acute cerebrovascular diseases, admitted from March 1st to April 30th, 2020, were collected. A comparison was made of the demographical and clinical features of both SARS-CoV-2 positive and negative patients with ICH.

Results: 949 patients were enrolled (average age 73.4 years; 52.7% males); 135 patients had haemorrhagic stroke and 127 (13.4%) had a primary ICH. Only 16 patients with ICH (12.6%) had laboratory confirmed SARS-CoV-2 infection, both symptomatic and asymptomatic. SARS-CoV-2 related pneumonia or respiratory distress (OR 5.4), lobar location (OR 5.0) and previous antiplatelet or anticoagulant treatment (OR 2.9) 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 (37.5% vs 23.4%, p = 0.2).

Discussion: ICH patients with COVID-19 did not experience an increase in mortality as striking as ischemic stroke. The inflammatory response and respiratory complications could justify the slight increase of death in ICH. Bleeding sites and previous antiplatelet or anticoagulant treatment were the only other predictors of a worse outcome.

Keywords: COVID-19; Intracerebral haemorrhage; SARS-CoV-2; Stroke.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a. Clinical and demographical features of SARS-CoV-2 negative and positive patients. The percentages were calculated on the total number of patients for whom that item was available. 1b. In-Hospital mortality index in SARS-CoV-2 negative and positive patients. SARS-CoV-2 positive patients were subdivided by respiratory involvement.
Fig. 2
Fig. 2
Multivariate analysis on mortality outcome of the main variables significant with p < 0.1 at univariate testing and with complete data collection.
See this image and copyright information in PMC

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