Subarachnoid Hemorrhage and COVID-19: An Analysis of 282,718 Patients

Qureshi, Adnan I; Baskett, William I; Huang, Wei; Shyu, Daniel; Myers, Danny; Lobanova, Iryna; Ishfaq, Muhammad F; Naqvi, S. Hasan; French, Brandi R; Siddiq, Farhan; Gomez, Camilo R.

doi:10.1016/j.wneu.2021.04.089

Cited by 33 publications

(36 citation statements)

References 40 publications

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“…I think that COVID-19 disease has an important effect on the cerebral vasculature by direct and indirect mechanisms that lead to endothelial damage and dysfunction. As mentioned earlier, in the study of Qureshi et al, 1 more cases of pneumonia were observed in SAH patients with COVID-19 infection than non−COVID-19 infection (58.1% vs. 21.3%). The problem is that all patients with pneumonia were in the same category, but the results of severe and mild pneumonia may not be the same.…”

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confidence: 57%

“…I read with great interest the article by Qureshi et al. 1 Many manuscripts have appeared in the literature about the subarachnoid hemorrhage (SAH)-producing effect of COVID-19 infection. 2 , 3 , 4 , 5 In the mentioned study, the authors studied the risk of SAH in 85,645 patients with COVID-19 infection.…”

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confidence: 99%

“…The authors found a lower risk of SAH in patients with COVID-19 (odds ratio 0.5, 95% confidence interval 0.4e0.7, P < 0.0001) after adjusting for sex, age strata, race/ethnicity, hypertension, and nicotine dependence/tobacco use. 1 They also noted that pneumonia (58.1% vs. 21.3%, P < 0.0001), acute kidney injury (43% vs. 27.7%, P [0.0005), septic shock (44.2% vs. 20.7%, P < 0.0001), and respiratory failure (64.0% vs. 39.1%, P < 0.0001) were significantly higher among patients with SAH and COVID-19 compared with patients without COVID-19. My main concern is that all the COVID-19 patients had been analyzed in only 1 uniform group; that is, the authors did not divide the mild and severe COVID-19 patients.…”

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confidence: 99%

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Letter to the Editor Regarding “Subarachnoid Hemorrhage and COVID-19: An Analysis of 282,718 Patients”

Kanat

2021

World Neurosurgery

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Letter to the Editor Regarding “Subarachnoid Hemorrhage and COVID-19: An Analysis of 282,718 Patients”

Kanat

2021

World Neurosurgery

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“…We can, however, observe that all these patients but one had a GOS between 1 and 2. Higher mortality in patients with SAH and COVID-19 compared to those without COVID-19 has already been reported, due to a higher rate of systemic comorbidities such as pulmonary embolism, acute coronary syndrome, and respiratory failure [ 30 , 31 ]. The negative effects of COVID-19 on mortality and complications have been well documented [ 14 , 17 , 25 , 34 , 36 ].…”

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confidence: 99%

Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

et al. 2021

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Background Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort. Methods In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017–2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed. Results Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The “diagnostic delay” was significantly increased (+ 68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value = 0.030), while “therapeutic delay” did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value = 0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p = 0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Outcome Scale (GOS), five variables showed p-values < 0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia. Conclusions We documented a significantly increased “diagnostic delay” for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was experiencing, the Lombardy regional reorganization model, which allowed centralization of neurosurgical emergencies such as SAHs, avoided a “therapeutic delay” and led to results overall comparable to the control period.

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“… 2 Those reports are important because a comprehensive understanding of the pathophysiology is an important issue in neurosurgery. 3 , 4 However, Qureshi et al 5 reported that the risk of SAH was not increased in patients with COVID-19. I disagree with them.…”

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Letter to the Editor Regarding “Aneurysmal Subarachnoid Hemorrhage in COVID-19 Patients: A Case Series”

Kanat

2021

World Neurosurgery

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Subarachnoid Hemorrhage and COVID-19: An Analysis of 282,718 Patients

Cited by 33 publications

References 40 publications

Letter to the Editor Regarding “Subarachnoid Hemorrhage and COVID-19: An Analysis of 282,718 Patients”

Letter to the Editor Regarding “Subarachnoid Hemorrhage and COVID-19: An Analysis of 282,718 Patients”

Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

Letter to the Editor Regarding “Aneurysmal Subarachnoid Hemorrhage in COVID-19 Patients: A Case Series”

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