Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure : A Propensity Score-Matched Registry Study
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% without and with SARS-CoV-2, respectively, p = 0.21). Propensity score matching confirmed similar rates of ICH in both groups (12.8 vs. 19.1% without and with 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.
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:34 |
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| Enthalten in: |
Neurocritical care - 34(2021), 3 vom: 17. Juni, Seite 739-747 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lang, Corinna N [VerfasserIn] |
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| Links: |
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| Themen: |
ARDS |
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| Anmerkungen: |
Date Completed 17.06.2021 Date Revised 02.04.2024 published: Print-Electronic ErratumIn: Neurocrit Care. 2021 Apr 12;:. - PMID 33846902 Citation Status MEDLINE |
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| doi: |
10.1007/s12028-021-01202-7 |
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| funding: |
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| PPN (Katalog-ID): |
NLM321781627 |
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| 245 | 1 | 0 | |a Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure |b A Propensity Score-Matched Registry Study |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 17.06.2021 | ||
| 500 | |a Date Revised 02.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: Neurocrit Care. 2021 Apr 12;:. - PMID 33846902 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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% without and with SARS-CoV-2, respectively, p = 0.21). Propensity score matching confirmed similar rates of ICH in both groups (12.8 vs. 19.1% without and with SARS-CoV-2, respectively, p = 0.57), thus leveling out possible confounders | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a ARDS | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Intracerebral hemorrhage | |
| 700 | 1 | |a Dettinger, Johanna S |e verfasserin |4 aut | |
| 700 | 1 | |a Berchtold-Herz, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Utzolino, Stefan |e verfasserin |4 aut | |
| 700 | 1 | |a Bemtgen, Xavier |e verfasserin |4 aut | |
| 700 | 1 | |a Zotzmann, Viviane |e verfasserin |4 aut | |
| 700 | 1 | |a Schmid, Bonaventura |e verfasserin |4 aut | |
| 700 | 1 | |a Biever, Paul M |e verfasserin |4 aut | |
| 700 | 1 | |a Bode, Christoph |e verfasserin |4 aut | |
| 700 | 1 | |a Müller-Peltzer, Katharina |e verfasserin |4 aut | |
| 700 | 1 | |a Duerschmied, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Wengenmayer, Tobias |e verfasserin |4 aut | |
| 700 | 1 | |a Niesen, Wolf-Dirk |e verfasserin |4 aut | |
| 700 | 1 | |a Staudacher, Dawid L |e verfasserin |4 aut | |
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