Impact of COVID-19 on the hospitalization, treatment, and outcomes of intracerebral and subarachnoid hemorrhage in the United States.
Vijay M Ravindra, Ramesh Grandhi, Alen Delic, Samuel Hohmann, Ernie Shippey, David Tirschwell, Jennifer A Frontera, Shadi Yaghi, Jennifer J Majersik, Mohammad Anadani, Adam de Havenon
Author Information
Vijay M Ravindra: Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, United States of America.
Ramesh Grandhi: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America.
Alen Delic: Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America.
Samuel Hohmann: Research Analytics, Vizient Inc., Irving, Texas, United States of America.
Ernie Shippey: Research Analytics, Vizient Inc., Irving, Texas, United States of America.
David Tirschwell: Department of Neurology, University of Washington, Seattle, Washington, United States of America.
Jennifer A Frontera: Department of Neurology, NYU Langone Health, New York, New York, United States of America.
Shadi Yaghi: Department of Neurology, NYU Langone Health, New York, New York, United States of America.
Jennifer J Majersik: Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America.
Mohammad Anadani: Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, United States of America. ORCID
Adam de Havenon: Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America. ORCID
OBJECTIVE: To examine the outcomes of adult patients with spontaneous intracranial and subarachnoid hemorrhage diagnosed with comorbid COVID-19 infection in a large, geographically diverse cohort. METHODS: We performed a retrospective analysis using the Vizient Clinical Data Base. We separately compared two cohorts of patients with COVID-19 admitted April 1-October 31, 2020-patients with intracerebral hemorrhage (ICH) and those with subarachnoid hemorrhage (SAH)-with control patients with ICH or SAH who did not have COVID-19 admitted at the same hospitals in 2019. The primary outcome was in-hospital death. Favorable discharge and length of hospital and intensive-care stay were the secondary outcomes. We fit multivariate mixed-effects logistic regression models to our outcomes. RESULTS: There were 559 ICH-COVID patients and 23,378 ICH controls from 194 hospitals. In the ICH-COVID cohort versus controls, there was a significantly higher proportion of Hispanic patients (24.5% vs. 8.9%), Black patients (23.3% vs. 20.9%), nonsmokers (11.5% vs. 3.2%), obesity (31.3% vs. 13.5%), and diabetes (43.4% vs. 28.5%), and patients had a longer hospital stay (21.6 vs. 10.5 days), a longer intensive-care stay (16.5 vs. 6.0 days), and a higher in-hospital death rate (46.5% vs. 18.0%). Patients with ICH-COVID had an adjusted odds ratio (aOR) of 2.43 [1.96-3.00] for the outcome of death and an aOR of 0.55 [0.44-0.68] for favorable discharge. There were 212 SAH-COVID patients and 5,029 controls from 119 hospitals. The hospital (26.9 vs. 13.4 days) and intensive-care (21.9 vs. 9.6 days) length of stays and in-hospital death rate (42.9% vs. 14.8%) were higher in the SAH-COVID cohort compared with controls. Patients with SAH-COVID had an aOR of 1.81 [1.26-2.59] for an outcome of death and an aOR of 0.54 [0.37-0.78] for favorable discharge. CONCLUSIONS: Patients with spontaneous ICH or SAH and comorbid COVID infection were more likely to be a racial or ethnic minority, diabetic, and obese and to have higher rates of death and longer hospital length of stay when compared with controls.
