A Longitudinal Research on the Distribution and Prognosis of Intracerebral Hemorrhage During the COVID-19 Pandemic

Gangqiang Lin; Xueqian Xu; Xiaoqian Luan; Huihua Qiu; Shengfang Shao; Qingsong Wu; Wei Xu; Guiqian Huang; Jincai He; Liang Feng

doi:10.3389/fneur.2022.873061

A Longitudinal Research on the Distribution and Prognosis of Intracerebral Hemorrhage During the COVID-19 Pandemic

Front Neurol. 2022 Apr 18:13:873061. doi: 10.3389/fneur.2022.873061. eCollection 2022.

Authors

Gangqiang Lin¹, Xueqian Xu¹, Xiaoqian Luan¹, Huihua Qiu¹, Shengfang Shao², Qingsong Wu³, Wei Xu^{4

5}, Guiqian Huang¹, Jincai He¹, Liang Feng^{1

5}

Affiliations

¹ Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
² Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
³ Medical Record Room, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁴ Outpatient Office, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁵ Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Abstract

Purpose: Globally, intracerebral hemorrhage (ICH) is a common cerebrovascular disease. At the beginning of 2020, due to the coronavirus disease 2019 (COVID-19) pandemic, the allocation of medical resources and the patient treatment and referrals were affected to varying degrees. We aimed to determine the characteristics and prognoses and associated factors of patients with ICH.

Patients and methods: The baseline demographic characteristics and ICH outcomes were compared between patients diagnosed with ICH between January and June 2020 (the 2020 group) and between January and June 2019 (the 2019 group). COVID-19 positive patients were excluded from the study. A 30-day data from patients in the 2019 and 2020 groups were analyzed to create survival curves for these patients. We also used regression models to identify the significant determinants of poor outcomes [modified Rankin score (mRS): 3-6] and death.

Results: The number of patients diagnosed with ICH was slightly lower in the 2020 group (n = 707) than in the 2019 group (n = 719). During the lockdown period (February 2020), the admission rates for ICH decreased greatly by 35.1%. The distribution of the patients' domicile (P = 0.002) and the mRS (P < 0.001) differed significantly between the years. The survival curve revealed that the highest risk of death was in the acute stage (especially in the first 5 days) of ICH. At 30 days, mortality was 19.8% in February 2019 and 29.4% in February 2020 (P = 0.119). Multivariate analysis revealed age, baseline mRS, postoperative complications, massive brainstem hemorrhage, and creatinine as factors significantly associated with poor outcomes and death following ICH. Neurosurgery and massive supratentorial hemorrhage were only correlated with the risk of death.

Conclusion: During the lockdown period, the COVID-19 pandemic caused a decrease in the admission rates and severe conditions at admission due to strict traffic constraints for infection control. This led to high mortality and disability in patients with ICH. It is necessary to ensure an effective green channel and allocate adequate medical resources for patients to receive timely treatment and neurosurgery.

Keywords: COVID-19; intracerebral hemorrhage; lockdown period; longitudinal research; prognosis.