tetano
Editor, Senior Moderator
Neurocrit Care
. 2021 Feb 23.
doi: 10.1007/s12028-021-01202-7. Online ahead of print.
Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study
Corinna N Lang[SUP] 1 2 [/SUP], Johanna S Dettinger[SUP] 3 4 [/SUP], Michael Berchtold-Herz[SUP] 5 [/SUP], Stefan Utzolino[SUP] 6 [/SUP], Xavier Bemtgen[SUP] 3 4 [/SUP], Viviane Zotzmann[SUP] 3 4 [/SUP], Bonaventura Schmid[SUP] 7 [/SUP], Paul M Biever[SUP] 3 4 [/SUP], Christoph Bode[SUP] 3 4 [/SUP], Katharina M?ller-Peltzer[SUP] 8 [/SUP], Daniel Duerschmied[SUP] 3 4 [/SUP], Tobias Wengenmayer[SUP] 3 4 [/SUP], Wolf-Dirk Niesen[SUP] #[/SUP][SUP] 9 [/SUP], Dawid L Staudacher[SUP] #[/SUP][SUP] 3 4 [/SUP]
Affiliations
Abstract
Background: Hypercoagulability in Coronavirus Disease 2019 (COVID-19) causes deep vein thrombosis and pulmonary embolism necessitating systemic anticoagulation. Case reports of intracerebral hemorrhages in ventilated COVID-19 patients warrant precaution. It is unclear, however, if COVID-19 patients with acute respiratory distress syndrome (ARDS) with or without veno-venous extracorporeal membrane oxygenation therapy (VV-ECMO) have more intracerebral hemorrhages (ICH) compared to other ARDS patients.
Methods: We conducted a retrospective observational single-center study enrolling all patients with ARDS from 01/2018 to 05/2020. PCR-positive SARS-CoV-2 patients with ARDS were allocated to the COVID-19 group. Propensity score matching was performed for age, VV-ECMO, and bleeding risk.
Results: A total of 163 patients with moderate or severe ARDS were identified, 47 (28.8%) in the COVID-19 group, and 116 (71.2%) in the non-COVID-19 group. In 63/163 cases (38.7%), VV-ECMO therapy was required. The ICU survival was 52.8%. COVID-19 patients were older, more often male, and exhibited a lower SOFA score, but the groups showed similar rates of VV-ECMO therapy. Treatments with antiplatelet agents (p = 0.043) and therapeutic anticoagulation (p = 0.028) were significantly more frequent in the COVID-19 patients. ICH was detected in 22 patients (13.5%) with no statistical difference between the groups (11.2 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.21). Propensity score matching confirmed similar rates of ICH in both groups (12.8 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.57), thus leveling out possible confounders.
Conclusions: Intracerebral hemorrhage was detected in every tenth patient with ARDS. Despite statistically higher rates of antiplatelet therapy and therapeutic anticoagulation in COVID-19 patients, we found a similar rate of ICH in patients with ARDS due to COVID-19 compared to other causes of ARDS.
Keywords: ARDS; COVID-19; Intracerebral hemorrhage.
. 2021 Feb 23.
doi: 10.1007/s12028-021-01202-7. Online ahead of print.
Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study
Corinna N Lang[SUP] 1 2 [/SUP], Johanna S Dettinger[SUP] 3 4 [/SUP], Michael Berchtold-Herz[SUP] 5 [/SUP], Stefan Utzolino[SUP] 6 [/SUP], Xavier Bemtgen[SUP] 3 4 [/SUP], Viviane Zotzmann[SUP] 3 4 [/SUP], Bonaventura Schmid[SUP] 7 [/SUP], Paul M Biever[SUP] 3 4 [/SUP], Christoph Bode[SUP] 3 4 [/SUP], Katharina M?ller-Peltzer[SUP] 8 [/SUP], Daniel Duerschmied[SUP] 3 4 [/SUP], Tobias Wengenmayer[SUP] 3 4 [/SUP], Wolf-Dirk Niesen[SUP] #[/SUP][SUP] 9 [/SUP], Dawid L Staudacher[SUP] #[/SUP][SUP] 3 4 [/SUP]
Affiliations
- PMID: 33619668
- DOI: 10.1007/s12028-021-01202-7
Abstract
Background: Hypercoagulability in Coronavirus Disease 2019 (COVID-19) causes deep vein thrombosis and pulmonary embolism necessitating systemic anticoagulation. Case reports of intracerebral hemorrhages in ventilated COVID-19 patients warrant precaution. It is unclear, however, if COVID-19 patients with acute respiratory distress syndrome (ARDS) with or without veno-venous extracorporeal membrane oxygenation therapy (VV-ECMO) have more intracerebral hemorrhages (ICH) compared to other ARDS patients.
Methods: We conducted a retrospective observational single-center study enrolling all patients with ARDS from 01/2018 to 05/2020. PCR-positive SARS-CoV-2 patients with ARDS were allocated to the COVID-19 group. Propensity score matching was performed for age, VV-ECMO, and bleeding risk.
Results: A total of 163 patients with moderate or severe ARDS were identified, 47 (28.8%) in the COVID-19 group, and 116 (71.2%) in the non-COVID-19 group. In 63/163 cases (38.7%), VV-ECMO therapy was required. The ICU survival was 52.8%. COVID-19 patients were older, more often male, and exhibited a lower SOFA score, but the groups showed similar rates of VV-ECMO therapy. Treatments with antiplatelet agents (p = 0.043) and therapeutic anticoagulation (p = 0.028) were significantly more frequent in the COVID-19 patients. ICH was detected in 22 patients (13.5%) with no statistical difference between the groups (11.2 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.21). Propensity score matching confirmed similar rates of ICH in both groups (12.8 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.57), thus leveling out possible confounders.
Conclusions: Intracerebral hemorrhage was detected in every tenth patient with ARDS. Despite statistically higher rates of antiplatelet therapy and therapeutic anticoagulation in COVID-19 patients, we found a similar rate of ICH in patients with ARDS due to COVID-19 compared to other causes of ARDS.
Keywords: ARDS; COVID-19; Intracerebral hemorrhage.