İntrakranial Hemoraji ve SARS-CoV-2 Birlikteliğinin Mortalite Üzerine Etkisi

Yıl 2022, Cilt: 8 Sayı: 2, 223 - 232, 31.05.2022

Yavuz Erdem , Samet Dinç , Adem Kurtuluş

https://doi.org/10.19127/mbsjohs.1104293

Öz

Amaç:
SARS-CoV-2 dünyamızda hala yüksek mortalite ve morbiditeye neden olan bir pandemidir. SARS-CoV-2'nin akciğer ve diğer organ tutulumuna bağlı yüksek mortalite ve morbidite oranlarınının eşlik eden intrakraniyal olaylar varlığında daha da fazla olduğunu gözlemledik ve incelemek istedik.
Yöntemler:
Bu çalışma tek merkezli retrospektif bir kohort çalışmasıdır. Afyonkarahisar Devlet Hastanesi'ne Haziran 2020-Haziran 2021 tarihleri arasında başvuran, mevcut haliyle SARS-CoV-2 olarak değerlendirilen ve kafa içi kanaması tespit edilen hastalar değerlendirildi.
Bulgular:
Kohortumuzdaki 13 hastanın 7'sinde (%54) hipertansiyon, diabetes mellitus ve kronik böbrek yetmezliği gibi komorbiditeler vardı. Beş hastada intraparankimal hematom, 2 hastada kronik subdural hematom, 1 hastada akut subdural hematom ve 4 hastada subaraknoid kanama görüldü. Çalışmamızda 5 hastaya dekompresif kraniektomi ve hematom cerrahisi yapıldı. Çalışmamıza dahil edilen hastalardan dokuzu yoğun bakım ünitesindeki takip ve tedavileri sonucunda kaybedildi ve ölüm oranı %69 olarak bulundu.
Sonuç:
SARS-CoV-2 enfeksiyonu olan hastalarda nadiren intrakraniyal kanamalar oluşabilmekte ve zaten oldukça ölümcül olan intraserebral kanamaların daha ölümcül olduğu gözlemlenmektedir. Ayrıca COVID-19 enfeksiyonunun kafa içi kanamalar için bir risk faktörü olduğu düşünülmektedir.

Anahtar Kelimeler

İntrakranial hemoraji, antikoagülan, covid-19, mortalite

The Effect of Intracranial Hemorrhage and SARS-CoV-2 Association on Mortality

Öz

Objective: SARS-CoV-2 is a pandemic that still causes high mortality and morbidity in our world. We observed and wanted to examine the high mortality and morbidity rates of SARS-CoV-2 due to lung and other organ involvement, and even more mortality in the presence of accompanying intracranial events.
Methods: This study is a single-center retrospective cohort study. Patients who applied to Afyonkarahisar State Hospital between June 2020 and June 2021, who were evaluated as SARS-CoV-2 in their current state and who were found to have an intracranial hemorrhage, were evaluated.
Results: Of the 13 patients in our cohort, 7 (54%) had comorbidities such as hypertension, diabetes mellitus, and chronic renal failure. The intraparenchymal hematoma was observed in 5 patients, chronic subdural hematoma in 2 patients, acute subdural hematoma in 1 patient, and subarachnoid hemorrhage in 4 patients. Decompressive craniectomy and hematoma evacuation were performed on 5 patients in our study. Nine of the patients included in our study died as a result of their follow-up and treatment in the intensive care unit, and the mortality rate was 69%.
Conclusion: Intracranial hemorrhages may occur rarely in patients with SARS-CoV-2 infection, and it is observed that intracerebral hemorrhages, which are already quite mortal, are more mortal. In addition, COVID-19 infection is thought to be a risk factor for intracranial hemorrhages.

Anahtar Kelimeler

Intracranial hemorrhages, anticoagulants, covid-19, mortality

Kaynakça

• 1. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients with Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-690. doi:10.1001/jamaneurol.2020.1127
• 2. Unüvar A. COVID-19 and Coagulopathy COVID-19 and Coagulopathy COVID-19 Associated Coagulopathy. Journal of Health Science Advanced Studies. 2020;3:53-62. doi:10.26650/JARHS2020-S1-0007
• 3. Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19 and intracerebral haemorrhage: causative or coincidental? New Microbes New Infect. 2020;35:0-1. doi:10.1016/j.nmni.2020.100669
• 4. Benger M, Williams O, Siddiqui J, Sztriha L. Intracerebral haemorrhage and COVID-19: Clinical characteristics from a case series. Brain Behav Immun. 2020;88(June):940-944. doi:10.1016/j.bbi.2020.06.005
• 5. Thachil J, Tang N, Gando S, Falanga A, Jattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-1026. doi:10.1111/jth.14810
• 6. Dogra S, Jain R, Cao M, Bilaloglu S, Zagzag D, Hochman S, et al. Hemorrhagic stroke and anticoagulation in COVID-19. J Stroke Cerebrovasc Dis. 2020;29(8):104984. doi:10.1016/j.jstrokecerebrovasdis.2020.104984
• 7. Rymer MM. Hemorrhagic stroke: intracerebral hemorrhage. Mo Med. 2011;108(1):50-54.
• 8. Cheruiyot I, Sehmi P, Ominde B, Bundi P, Mislani M, Ngure B, et al. Intracranial hemorrhage in coronavirus disease 2019 (COVID-19) patients. Neurol Sci. 2021;42(1):25-33. doi:10.1007/s10072-020-04870-z
• 9. Prokop M, Everdingen W Van, Vellinga T van R, Ufford HQ Van, Stöger L, Beenen L, et al. CO-RADS-A categorical CT assessment scheme for patients with suspected COVID-19: definition and evaluation original research. Radiology. 2020;(1):1-37.
• 10. Jaergere T, Krdzalic J, Fasen B, Kwee R. Radiological Society of North America Chest Classification System for Reporting COVID-19 Pneumonia: Interobserver Variability and Correlation with RT-PCR. Radiol Cardiothorac Imaging. Published online 2020. https://doi.org/10.1148/ryct.2020200213
• 11. Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, Zambrano-Achig P, Campo R, Ciapponi A, et al. False-negative results of initial RT-PCR assays for COVID-19: A systematic review. PLoS One. 2020;15(12 December):1-19. doi:10.1371/journal.pone.0242958
• 12. Altschul DJ, Unda SR, de La Garza Ramos R, Zampolin R, Benton J, Holland R, et al. Hemorrhagic presentations of COVID-19: Risk factors for mortality. Clin Neurol Neurosurg. 2020;198(June):106112. doi:10.1016/j.clineuro.2020.106112
• 13. Melmed KR, Cao M, Dogra S, Zhang R, Yaghi S, Lewis A, et al. Risk factors for intracerebral hemorrhage in patients with COVID-19. J Thromb Thrombolysis. 2021;51(4):953-960. doi:10.1007/s11239-020-02288-0
• 14. Erol TA, Asar S, Sabaz SM, Bilgin OB, Cukurova Z. Risk Factors for 28-day Mortality Among COVID-19 Patients in an Intensive Care Unit of a Tertiary Care Center in Istanbul.Med J Bakirkoy 2021;17(1):100-7
• 15. Mishra S, Choueka M, Wang Q, Hu C, Visone S, Silver M, et al. Intracranial Hemorrhage in COVID-19 Patients. J Stroke Cerebrovasc Dis. 2021;30(4):105603. doi:10.1016/j.jstrokecerebrovasdis.2021.105603
• 16. Nawabi J, Morotti A, Wildgruber M, Boulouis G, Kraehling H, Schlunk F, et al. Clinical and Imaging Characteristics in Patients with SARS-CoV-2 Infection and Acute Intracranial Hemorrhage. J Clin Med. 2020;9(8):2543. doi:10.3390/jcm9082543
• 17. Ghasemnejad-Berenji M, Pashapour S. Favipiravir and COVID-19: A Simplified Summary. Drug Res (Stuttg). 2021;71(3):166-170. doi:10.1055/a-1296-7935
• 18. Yüksel U, Ogden M, Akkurt I, Bakar B, Kısa U, Ozveren MF. Biochemical Markers in the Prognosis of Intracranial Hemorrhages. Cukurova Med J. 2018;43(2):350-359.doi:10.17826/cumj.341851
• 19. Napoli M Di, Parry-Jones AR, Smith CJ, Hopkins SJ, Slevin M, Masotti L, et al. C-reactive protein predicts hematoma growth in intracerebral hemorrhage. Stroke. 2014;45(1):59-65. doi:10.1161/STROKEAHA.113.001721
• 20. Macdonald RL. Management of Intracranial Hemorrhage in the Anticoagulated Patient. Neurosurg Clin N Am. 2018;29(4):605-613. doi:10.1016/j.nec.2018.06.013
• 21. Pavlov V, Beylerli O, Gareev I, Torres Solis LF, Herrera AS, Aliev G. COVID-19-Related Intracerebral Hemorrhage. Front Aging Neurosci. 2020;12(October):1-6. doi:10.3389/fnagi.2020.600172
• 22. Abdulazim A, Ebert A, Etminan N, Szabo K, Alonso A. Negative Impact of the COVID-19 Pandemic on Admissions for Intracranial Hemorrhage. Front Neurol. 2020;11(September):1-5. doi:10.3389/fneur.2020.584522
• 23. Hostettler IC, Seiffge DJ, Werring DJ. Intracerebral hemorrhage: An update on diagnosis and treatment. Expert Rev Neurother. 2019;19(7):679-694. doi:10.1080/14737175.2019.1623671