Risk and extent of intracranial haemorrhage in patients with SARS-CoV-2 infection admitted to intensive care unit

Abstract

Introduction The severe acute respiratory syndrome-coronavirus-2 (SARS-Cov2) pandemic has been overcome after more than 3 years1. Several patients were affected by neurosurgery-related complications during SARS-CoV-2 infection 2,3. The aim of the present study was to assess the incidence of SARS-Cov2-associated intracranial hemorrhage (ICH), the reasons therefore and to identify predictors of outcome. Methods We retrospectively analyzed data of patients with SARS-CoV-2 infection admitted to the intensive care unit (ICU) of our hospital in the period of 2 years. We included all patients who acquired a SARS-CoV-2 infection and required intensive care treatment. All patients were followed up until death or discharge from ICU. The primary outcome was the incidence of mortality during ICU stay and occurrence of ICH. We compared survivors and non-survivors with ICH during their ICU stay and patients who developed intracerebral hemorrhage with those who did not. Results Four hundred and sixty-seven patients with a mean age of 64.33 (± 14.76) years with confirmed SARS-CoV2-infection were registered. The mortality rate during ICU stay was 32.11%. Within the two years period, 18 out of 467 patients (3,85%) with spontaneous SARS-Cov2-associated ICH were treated in our department. In the multivariate analysis, ICH was not identified as an independent risk factor for mortality. ECMO treatment (OR 5.130, 95%: 1.739-15.133, p=0.003) was the only independent risk factor of the occurrence of ICH. Conclusion SARS-Cov2-associated ICH itself did not result in increased mortality in patients with SARS-CoV-2 infection treated on the ICU. We hypothesize, that increased mortality in patients with ICH is caused by other comorbidities such as renal failure requiring dialysis, age over 65, the use of ECMO and mechanical ventilation. The use of ECMO was found to be the strongest independent risk factor associated with the occurrence of ICH.