Risk factors for intracerebral hemorrhage in patients with COVID-19
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Risk factors for intracerebral hemorrhage in patients with COVID‑19 Kara R. Melmed1,2 · Meng Cao3 · Siddhant Dogra4 · Ruina Zhang3 · Shadi Yaghi1 · Ariane Lewis1,2 · Rajan Jain2,4 · Seda Bilaloglu5 · Ji Chen5 · Barry M. Czeisler1,2 · Eytan Raz4 · Aaron Lord1 · Jeffrey S. Berger6 · Jennifer A. Frontera1 Accepted: 17 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Intracerebral hemorrhage (ICH) can be a devastating complication of coronavirus disease (COVID-19). We aimed to assess risk factors associated with ICH in this population. We performed a retrospective cohort study of adult patients admitted to NYU Langone Health system between March 1 and April 27 2020 with a positive nasopharyngeal swab polymerase chain reaction test result and presence of primary nontraumatic intracranial hemorrhage or hemorrhagic conversion of ischemic stroke on neuroimaging. Patients with intracranial procedures, malignancy, or vascular malformation were excluded. We used regression models to estimate odds ratios and 95% confidence intervals (OR, 95% CI) of the association between ICH and covariates. We also used regression models to determine association between ICH and mortality. Among 3824 patients admitted with COVID-19, 755 patients had neuroimaging and 416 patients were identified after exclusion criteria were applied. The mean (standard deviation) age was 69.3 (16.2), 35.8% were women, and 34.9% were on therapeutic anticoagulation. ICH occurred in 33 (7.9%) patients. Older age, non-Caucasian race, respiratory failure requiring mechanical ventilation, and therapeutic anticoagulation were associated with ICH on univariate analysis (p < 0.01 for each variable). In adjusted regression models, anticoagulation use was associated with a five-fold increased risk of ICH (OR 5.26, 95% CI 2.33–12.24, p < 0.001). ICH was associated with increased mortality (adjusted OR 2.6, 95 % CI 1.2–5.9). Anticoagulation use is associated with increased risk of ICH in patients with COVID-19. Further investigation is required to elucidate underlying mechanisms and prevention strategies in this population. Keywords Anticoagulation · COVID-19 · Hemorrhagic stroke · Intracerebral hemorrhage · Mechanical ventilation
Highlights Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02288-0) contains supplementary material, which is available to authorized users. * Kara R. Melmed [email protected] 1
2
Department of Neurology, New York University Langone Health, New York, NY, USA Department of Neurosurgery, New York University Langone Health, New York, NY, USA
3
Department of Medicine, New York University Langone Health, New York, NY, USA
4
Department of Radiology, New York University Langone Health, New York, NY, USA
5
Department of Population Health, New York University Langone Health, New York, NY, USA
6
Department of Cardiology, New York University Langone Health, New York, NY, USA
• Intracerebral hemorrhage (ICH) occurs in pati
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