COVID-19 Infection and Associated Outcomes in Patients with Nontraumatic Intracerebral Hemorrhage: Analysis of National Inpatient Sample 2020-2022.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.