Hemorrhagic presentations of COVID-19: Risk factors for mortality
Hemorrhagic presentations of COVID-19: Risk factors for mortality
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DOI：
10.1016/j.clineuro.2020.106112
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发表时间：
2020-11-01
影响因子：
1.9
通讯作者：
Haranhalli, Neil
中科院分区：
文献类型：
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作者：
Altschul, David J.;Unda, Santiago R.;Haranhalli, Neil
目的：我们的目的是描述出血和COVID-19患者的发病率、死亡风险，并确定死亡风险因素。方法：这项回顾性队列研究包括一组在我们的医疗保健网络的三家主要医院之一住院的患者，包括一个学术医疗中心和综合中风中心，该中心接受来自八家社区医院的复杂病例的转移，2020年3月1日至5月1日期间。所有接受神经轴成像并对COVID-19进行阳性PCR检测的患者均由主治神经放射科医生进行识别和审查。记录人口统计学和合并症。从出血事件当天开始记录生物标志物。记录出血事件当天的生命体征和入院时的机械通气医嘱。影像学表现分为5种亚型：急性硬膜下血肿（SDH）、蛛网膜下腔出血（SAH）、多室出血（MCH）、多灶性脑内出血（MFH）和局灶性脑内出血（ITCH）。结果：在5227名COVID-19患者中，我们发现共有35名患者发生了某种出血。整个队列的死亡率为45.7%（n = 16）。SDH患者的死亡率为35.3%（n = 6），SAH患者的死亡率为50%（n = 1），MCH患者的死亡率为71.4%（n = 5），MFH患者的死亡率为50（n = 2），fICH患者的死亡率为40%（n = 2）。需要机械通气的重度肺部COVID患者（OR 10.24 [.43 - 243.12] p = 0.015），出血事件当天INR > 1.2（OR 14.36 [1.69 - 122.14] p = 0.015]，自发性出血患者的死亡风险显著高于创伤性出血患者（OR 6.11 [0.31 - 118.89] p = 0.023）。COVID-19的出血表现是一种罕见但严重的疾病表现方式。重要的是，神经外科医生要认识到，患者可以在没有原发性肺部症状的情况下表现出这些结果，并且严重的肺部症状、INR升高和自发性出血表现与死亡风险增加相关。
Objective: We aim to characterize the incidence, risk for mortality, and identify risk factors for mortality in patients presenting with hemorrhage and COVID-19.Methods: This retrospective cohort study included a cohort of patients admitted to one of three major hospitals of our healthcare network including, an academic medical center and comprehensive stroke center, which accepts transfers for complex cases from eight community hospitals, during March 1 to May 1, 2020. All patients that received imaging of the neuroaxis and had positive PCR testing for COVID-19 were identified and reviewed by an attending neuroradiologist. Demographics and comorbidities were recorded. Biomarkers were recorded from the day of the hemorrhagic event. Vital signs from the day of the hemorrhagic event mechanical ventilation orders at admission were recorded. Imaging findings were divided into 5 subtypes; acute subdural hematoma (SDH), subarachnoid hemorrhage (SAH), multi-compartmental hemorrhage (MCH), mull-focal intracerebral hemorrhage (MFH), and focal intracerebral hemorrhage (ITCH). Outcomes were recorded as non-routine discharge and mortality.Results: We found a total of 35 out of 5227 patients with COVID-19 that had hemorrhage of some kind. Mortality for the entire cohort was 45.7 % (n = 16). SDH patients had a mortality rate of 35.3 % (n = 6), SAH had a mortality of 50 % (n = 1), MCH patients had a mortality of 71.4 % (n = 5), MFH patients had a mortality of 50 (n = 2), fICH patients had a mortality of 40 % (n = 2). Patients with severe pulmonary COVID requiring mechanical ventilation (OR 10.24 [.43 - 243.12] p = 0.015), with INR > 1.2 on the day of the hemorrhagic event (OR 14.36 [1.69 - 122.14] p = 0.015], and patients presenting with spontaneous vs. traumatic hemorrhage (OR 6.11 [.31 -118.89] p = 0.023) had significantly higher risk for mortality.Conclusions: Hemorrhagic presentations with COVID-19 are a rare but serious way in which the illness can manifest. It is important for neurosurgeons to realize that patients can present with these findings without primary pulmonary symptoms, and that severe pulmonary symptoms, elevated INR, and spontaneous hemorrhagic presentations is associated with increased risk for mortality.