COVID-19 肺功能衰竭患者的脑出血：一项倾向评分匹配的登记研究,Neurocritical Care

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COVID-19 肺功能衰竭患者的脑出血：一项倾向评分匹配的登记研究
Neurocritical Care ( IF 3.1 ) Pub Date : 2021-02-23 , DOI: 10.1007/s12028-021-01202-7
Corinna N Lang _{1,

2} , Johanna S Dettinger _{1,

2} , Michael Berchtold-Herz ₃ , Stefan Utzolino ₄ , Xavier Bemtgen _{1,

2} , Viviane Zotzmann _{1,

2} , Bonaventura Schmid ₅ , Paul M Biever _{1,

2} , Christoph Bode _{1,

2} , Katharina Müller-Peltzer ₆ , Daniel Duerschmied _{1,

2} , Tobias Wengenmayer _{1,

2} , Wolf-Dirk Niesen ₇ , Dawid L Staudacher _{1,

2}

Affiliation

背景

2019 年冠状病毒病 (COVID-19) 的高凝状态导致深静脉血栓形成和肺栓塞，需要全身抗凝。通气的 COVID-19 患者脑内出血的病例报告需要采取预防措施。然而，目前尚不清楚是否与其他 ARDS 患者相比，患有急性呼吸窘迫综合征 (ARDS) 的 COVID-19 患者在接受或不接受静脉-静脉体外膜肺氧合治疗 (VV-ECMO) 的情况下发生更多的脑出血 (ICH)。

方法

我们进行了一项回顾性观察性单中心研究，从 01/2018 到 05/2020 招募了所有 ARDS 患者。患有 ARDS 的 PCR 阳性 SARS-CoV-2 患者被分配到 COVID-19 组。对年龄、VV-ECMO 和出血风险进行倾向评分匹配。

结果

共确定了 163 名中度或重度 ARDS 患者，其中 COVID-19 组 47 人（28.8%），非 COVID-19 组 116 人（71.2%）。在 63/163 例 (38.7%) 中，需要 VV-ECMO 治疗。ICU生存率为52.8%。COVID-19 患者年龄较大，男性较多，SOFA 评分较低，但两组患者的 VV-ECMO 治疗率相似。在 COVID-19 患者中，抗血小板药物 ( p = 0.043) 和治疗性抗凝剂 ( p = 0.028) 的治疗频率明显更高。在 22 名患者 (13.5%) 中检测到 ICH，两组之间没有统计学差异（分别为 11.2% 和 19.1%，有和没有 SARS-CoV-2，p = 0.21)。倾向评分匹配证实了两组的 ICH 发生率相似（在有和没有 SARS-CoV-2 的情况下分别为 12.8% 和 19.1%，p = 0.57），从而消除了可能的混杂因素。

结论

每 10 名 ARDS 患者检测到脑出血。尽管 COVID-19 患者的抗血小板治疗和治疗性抗凝治疗率在统计学上更高，但我们发现与其他原因导致的 ARDS 相比，COVID-19 导致的 ARDS 患者的 ICH 发生率相似。

"点击查看英文标题和摘要"

Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study

Background

Hypercoagulability in Coronavirus Disease 2019 (COVID-19) causes deep vein thrombosis and pulmonary embolism necessitating systemic anticoagulation. Case reports of intracerebral hemorrhages in ventilated COVID-19 patients warrant precaution. It is unclear, however, if COVID-19 patients with acute respiratory distress syndrome (ARDS) with or without veno-venous extracorporeal membrane oxygenation therapy (VV-ECMO) have more intracerebral hemorrhages (ICH) compared to other ARDS patients.

Methods

We conducted a retrospective observational single-center study enrolling all patients with ARDS from 01/2018 to 05/2020. PCR-positive SARS-CoV-2 patients with ARDS were allocated to the COVID-19 group. Propensity score matching was performed for age, VV-ECMO, and bleeding risk.

Results

A total of 163 patients with moderate or severe ARDS were identified, 47 (28.8%) in the COVID-19 group, and 116 (71.2%) in the non-COVID-19 group. In 63/163 cases (38.7%), VV-ECMO therapy was required. The ICU survival was 52.8%. COVID-19 patients were older, more often male, and exhibited a lower SOFA score, but the groups showed similar rates of VV-ECMO therapy. Treatments with antiplatelet agents (p = 0.043) and therapeutic anticoagulation (p = 0.028) were significantly more frequent in the COVID-19 patients. ICH was detected in 22 patients (13.5%) with no statistical difference between the groups (11.2 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.21). Propensity score matching confirmed similar rates of ICH in both groups (12.8 vs. 19.1% with and without SARS-CoV-2, respectively, p = 0.57), thus leveling out possible confounders.

Conclusions

Intracerebral hemorrhage was detected in every tenth patient with ARDS. Despite statistically higher rates of antiplatelet therapy and therapeutic anticoagulation in COVID-19 patients, we found a similar rate of ICH in patients with ARDS due to COVID-19 compared to other causes of ARDS.

更新日期：2021-02-23

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