Clinical Characteristics and Mortality of Intensive Care Patients With Intracerebral Hemorrhage and COVID-19: A Retrospective Cohort Analysis

Abstract

Background: Since the COVID-19 pandemic, many studies have reported severe neurologic effects of the infection on the brain. Intracerebral hemorrhage (ICH) is a particular pathology that can result in these devastating neurologic effects.

Objectives: The primary aim of our study is to investigate the possible difference in the clinical and laboratory characteristics of ICH between patients with positive COVID-19 tests and those with negative tests. The potential effect of this difference on the prognosis of the patients during their stay in the intensive care unit (ICU) is a secondary aim of the study.

Methods: In this retrospective cohort review, our data were collected from the electronic medical database of the Benghazi Medical Center (BMC) for the period from January 2021 to June 2022. We depended mainly on the admission paper information documented by emergency doctors, and mortality was measured depending on the clinical status after discharge from the ICU.

Results: This study included a sample of 72 patients, 34 patients (47.2%) were considered COVID-19 positive, and 38 patients (52.8%) were COVID-19 negative. The difference between groups was significant in ICH score ≥3 (higher in positive patients), INR (lower in positive patients), the incidence of new-onset hypertension (higher in positive patients), location of hematoma (infratentorial in positive patients), and intraventricular hemorrhage (IVH) extension (more in positive patients). Also, COVID-19 was significantly associated with ICH score ≥3 (OR 4.6, 95% CI 1.2 - 18.6, p = 0.03, R² = 0.16), INR (𝛃 = 0.35, 95% CI 0.09 - 0.62, p < 0.003, R² = 0.136), risk of ventilation (OR 14.1, 95% CI 3.5 - 56.9, p < 0.001, R² = 0.26), hydrocephalus (OR 9.41, 95% CI 2.72 - 32.5, p = 0.001, R² = 0.19), infratentorial location (OR 3.7, 95% CI 1.1 - 12.5, p = 0.04, R² = 0.14), IVH extension (OR 3.5, 95% CI 1.2 - 10.4, p = 0.03, R² = 0.09), new-onset hypertension (OR 4.2, 95% CI 1.5 - 11.9, p = 0.007, R² = 0.10), and mortality (OR 4.9, 95% CI 1.6 - 15.3, p = 0.04, R² = 0.15). The difference in survivability between groups was statistically insignificant (X² = 0.41, log-rank, P = 0.53).

Conclusion: The current study demonstrates, with sufficient evidence, that COVID-19 infection causes a significant change in some critical baseline characteristics like INR values, location, and IVH extension that influence the prognosis of ICH in ICU patients.

Keywords: clinical characteristics; covid-19; intensive care unit; intracerebral hemorrhage; mortality.

Figure 1. The distribution of age with COVID-19 and mortality

Shown is the violin plot that demonstrates a lower median age of mortality for the positive COVID-19 patients with high probability in comparison to those with negative tests. This difference was statistically and clinically insignificant (P > 0.05).

Figure 2. The distribution of clinical outcomes with COVID-19 and mortality

Shown is a bar graph that demonstrates the difference in outcome between the two groups; higher mortality was observed in positive cases. LAMA, leave against medical attention “including the transfer to another hospital”; NOS, non-survivor; PEFD, persistent focal deficit; REST, restore to premorbid state

Figure 3. Kaplan-Meier survival analysis comparison curves in patients with ICH with/without COVID-19 infection

Shown is the Kaplan-Meier survival estimate of the time from ICU admission to death or ICU discharge. The noted difference in the median survivability between the two groups was clinically and statistically not significant (X² = 0.41, log-rank, P = 0.53).

Figure 4. Predicted probability of new-onset hypertension after COVID-19 infection with 95% CI

Shown are the predicted margins of the probability of new-onset hypertension between the two groups; the margins graph shows an increased probability of getting new-onset hypertension after COVID-19 infection.