Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study (Preprint)

Abstract

BACKGROUND The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH). OBJECTIVE This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH. METHODS Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups. RESULTS From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (<i>P</i><.001) with a history of ischemic stroke (<i>P</i>=.04), shorter time from onset to admission (<i>P</i><.001), higher blood pressure (<i>P</i><.001), higher fasting blood glucose (<i>P</i>=.003), larger hematoma volume (<i>P</i><.001), and more common deep ICH (<i>P</i>=.01) and intraventricular hemorrhage (<i>P</i>=.02). These patients required more intensive care unit treatment (<i>P</i><.001) and preferred to go to the hospital directly rather than call an ambulance (<i>P</i><.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RR<sub>adjusted</sub>] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RR<sub>adjusted</sub> 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RR<sub>adjusted</sub> 3.103, 95% CI 2.156-4.465), 1-month (RR<sub>adjusted</sub> 1.064, 95% CI 1.042-1.087), and 3-month (RR<sub>adjusted</sub> 1.069, 95% CI 1.045-1.093) mortality. CONCLUSIONS Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817