Loggini Andrea, Saleh Velez Faddi G, Henson Jessie, Hornik Jonatan, Schwertman Amber, Dallow Karam, Hornik Alejandro, Battaglini Denise
Brain and Spine Institute, Southern Illinois Healthcare, Carbondale, IL, USA.
School of Medicine, Southern Illinois University, Carbondale, IL, USA.
Neurocrit Care. 2025 Apr 14. doi: 10.1007/s12028-025-02259-4.
Nontraumatic intracerebral hemorrhage (ICH) is a devastating form of stroke with high mortality and morbidity. The COVID-19 pandemic introduced additional complexities and challenges in managing ICH. This study evaluates the impact of concurrent COVID-19 infection on the demographics, outcomes, and resource use of patients with ICH. The primary outcome was in-hospital mortality, and secondary outcomes included neurological and systemic complications, length of stay, and cost of hospitalization.
The National Inpatient Sample database was screened to identify patients with and without COVID-19 infection and ICH from 2020 to 2022. Sociodemographic characteristics, comorbidities, and clinical severity were compared between the two groups. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the preselected outcomes. A p value of < 0.05 was considered statistically significant.
A total of 99,780 patients with ICH were included, of whom 4917 (4.9%) had concomitant COVID-19 infection. COVID-19-positive patients with ICH were younger (median 66 [interquartile range (IQR) 55-76] vs. 68 [IQR 57-78], years), more likely to identify as Black (25.6 vs. 23.5%) or Hispanic (17.1 vs. 10.9%), and more frequently in the lower quartile of median household income (31.4 vs. 29.2%) (p < 0.05 for all). Distinct multivariate regression models adjusted for demographics, baseline comorbidities, and ICH severity revealed that COVID-19 infection was independently associated with higher odds of in-hospital mortality (aOR 2.432; 95% confidence interval [CI] 2.273-2.602), systemic complications (aOR 1.527; 95% CI 1.432-1.628), longer hospital stay (aOR 2.115; 95% CI 1.957-2.286), and higher hospitalization costs (aOR 1.256; 95% CI 1.162-1.357). In contrast, COVID-19 infection was also associated with lower odds of neurological complications (aOR 0.811; 95% CI 0.76-0.865).
COVID-19 exacerbated the existing disparities in ICH, disproportionately affecting younger, socioeconomically disadvantaged, and minority populations. Additionally, patients with ICH with concomitant COVID-19 infection experienced worse clinical outcomes and greater healthcare resource use. These findings highlight the impact that the pandemic had on patients with acute neurological conditions, particularly among more vulnerable populations.
非创伤性脑出血（ICH）是一种具有高死亡率和高发病率的毁灭性中风形式。新冠疫情给ICH的管理带来了更多复杂性和挑战。本研究评估了新冠病毒合并感染对ICH患者的人口统计学特征、预后及资源利用的影响。主要结局是住院死亡率，次要结局包括神经和全身并发症、住院时间及住院费用。
对国家住院患者样本数据库进行筛查，以识别2020年至2022年期间患有和未患有新冠病毒感染及ICH的患者。比较两组患者的社会人口学特征、合并症及临床严重程度。采用多因素逻辑回归计算预选结局的调整优势比（aOR）。p值<0.05被认为具有统计学意义。
共纳入99780例ICH患者，其中4917例（4.9%）合并新冠病毒感染。合并新冠病毒感染的ICH阳性患者更年轻（中位年龄66岁[四分位间距（IQR）55 - 76岁] vs. 68岁[IQR 57 - 78岁]），更有可能为黑人（25.6% vs. 23.5%）或西班牙裔（17.1% vs. 10.9%），且更常处于家庭收入中位数的下四分位数（31.4% vs. 29.2%）（所有p<0.05）。针对人口统计学、基线合并症及ICH严重程度进行调整的不同多因素回归模型显示，新冠病毒感染与更高的住院死亡率（aOR 2.432；95%置信区间[CI] 2.273 - 2.602）、全身并发症（aOR 1.527；95% CI 1.432 - 1.628）、更长的住院时间（aOR 2.115；95% CI 1.957 - 2.286）及更高的住院费用（aOR 1.256；95% CI 1.162 - 1.357）独立相关。相比之下，新冠病毒感染也与更低的神经并发症发生率相关（aOR 0.811；95% CI 0.76 - 0.865）。
新冠疫情加剧了ICH现有的差异，对年轻、社会经济地位不利及少数族裔人群产生了不成比例的影响。此外，合并新冠病毒感染的ICH患者临床结局更差，医疗资源利用更多。这些发现凸显了疫情对急性神经系统疾病患者的影响，尤其是在更脆弱人群中。
