401 Risk Factors for Increased Mortality in Patients with ICH and COVID-19: Timing Matters

Abstract

INTRODUCTION: Intracerebral hemorrhage (ICH) has been reported with comorbid COVID-19 infection and is associated with significant morbidity and mortality. METHODS: The NIH N3C national database was used to retrospectively analyze COVID-19 infected patients within 1 month of ICH admitted after March 11, 2020. The primary endpoint was death during admission, and the cohort of patients who suffered fatalities were compared to those discharged from admission. Additional analyses compared patients diagnosed with ICH after COVID-19 infection versus those presenting with ICH and subsequent COVID infection. RESULTS: 1614 ICH-COVID patients from 55 sites were identified, 351 of which suffered fatalities. In the ICH-COVID fatality cohort versus those discharged, there was a significantly higher proportion of prior comorbid obesity (36.2% vs 28.3%), diabetes (48.1% vs 40.1%), atrial fibrillation (35.0% vs 24.8%), and heart failure (30.8% vs 23.8%). Racial and ethnic differences were not significant across the two cohorts. Of note, higher rates of hypertension and smoking were not observed. Increased complications of MI (18.2% vs 11.0%), PE (14.2% vs 9.5%), and DVT (19.7% vs 14.9%) were observed. The fatality cohort showed an increased proportion of patients presenting with ICH prior to COVID-19 infection compared to those diagnosed with ICH after COVID-19 infection. Analyses comparing the timing of ICH and COVID diagnoses regardless of outcome confirmed higher rates of mortality (28.4% vs 20.3%) in those with ICH followed by COVID-19 infection. To account for confounding non-survivable ICH in respective cohorts, fatalities within 2 days of ICH diagnosis were excluded and this finding remained significant. CONCLUSION: Fatalities from ICH and concurrent COVID-19 infection were increased for those with history of obesity, diabetes, atrial fibrillation and heart failure, and higher rates of MI, PE, and DVT were observed compared to non-fatal cases. Patients who presented with ICH and subsequently became COVID infected had higher mortality rate than those who suffered ICH after COVID.