Acute intracranial hemorrhage in 76 COVID-19 patients during the first and second pandemic waves

Biljana  Georgievski Brkić; Marjana Vukićević; Vladimir Debeljković; Ljubica  Nikčević-Krivokapić; Nataša Stanisavljević; Dejan Kostić; Filip Vitošević; Verica Jovanović; Slobodan Marinković

doi:10.2298/VSP230905065G

Biljana Georgievski Brkić Special Hospital for Cerebrovascular Diseases “Sveti Sava”, *Department of Neuroradiology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Marjana Vukićević University of Belgrade, Faculty of Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Vladimir Debeljković Special Hospital for Cerebrovascular Diseases “Sveti Sava”, Department of Neuroradiology, Belgrade, Serbia
Ljubica Nikčević-Krivokapić Special Hospital for Cerebrovascular Diseases “Sveti Sava”, Department of Neuroradiology, Department of Physical Therapy, Belgrade, Serbia
Nataša Stanisavljević University Hospital Medical Center “Bežanijska kosa”, Department of Hematology, Belgrade, Serbia
Dejan Kostić Military Medical Academy, Insitute of Radiology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Filip Vitošević Special Hospital for Cerebrovascular Diseases “Sveti Sava”, Department of Neurointervetion Radiology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
Verica Jovanović University of Belgrade, Faculty of Medicine, Institute of Public Health of Serbia “Dr. Milan Jovanović Batut”, Belgrade, Serbia
Slobodan Marinković University of Belgrade, Faculty of Medicine, Institute of Public Health of Serbia “Dr. Milan Jovanović Batut”, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP230905065G

Ključne reči: covid-19;, d-dimer;, krvarenje, intrakranijalno;, mortalitet;, faktori rizika;, srbija;, tomografija, kompjuterizovana, rendgenska

Sažetak

Uvod/Cilj. Nedovoljno je podataka o učestalosti intrakranijalnih krvarenja (IKK) u prvom talasu (beta varijanta virusa severe acute respiratory syndrome coronavirus 2 – SARS-CoV-2) i drugom talasu (delta varijanta virusa SARS-CoV-2) pandemije izazvane koronavirusom 2019 (COVID-19). Cilj rada bio je da se analizira pojava IKK kod obolelih od COVID-19 (CB). Metode. Od 505 CB koji su lečeni u Specijalnoj bolnici za cerebrovaskularne bolesti ,,Sveti Sava” tokom 2020–2021, IKK je dijagnostikovana kod 76 (15,1%) bolesnika. Prikupljeni su i analizirani dostupni podaci iz medicinske dokumentacije: klinički, demografski i radiološki (multislajsna kompjuterizovana tomografija endokranijuma). Rezultati. U prvom talasu je od 308 CB bilo njih 63 (20,5%) sa IKK. U drugom talasu je od 197 CB kod 13 (6,6%) bolesnika dijagnostikovana IKK, što je bila statistički značajna razlika (p < 0,002). Poređenjem dva talasa pandemije utvrđeno je da nije bilo statistički značajne razlike u postojanju hipertenzije (p = 0,271), dijabetesa melitusa (p = 0,558) i hronične opstruktivne bolesti pluća (p = 0,794) kod CB sa IKK. Međutim, pokazana je statistički značajna razlika u učestalosti bolesnika sa atrijalnom fibrilacijom i bolesnika koji su lečeni antikoagulantnim lekovima (p = 0,021 za obe učestalosti). Nije bilo statistički značajne razlike u učestalosti bolesnika sa temperaturom (p = 0,637), umorom (p = 0,587), neurološkim deficitom (p = 0,831), respiratornim simptomima (p = 0,289) i gubitkom svesti (p = 0,247). Vrednosti D-dimera u drugom talasu pandemije bile su statistički značajno niže (p = 0,003). Kombinacija ishemijskog moždanog udara i IKK bila je šest puta češća u drugom talasu (p = 0,003). Međutim, cerebralno parenhimsko krvarenje bilo je dva puta ređe (p = 0,001) u drugom talasu, ali sa statistički višom učestalošću multifokalnog (23,1%) i difuznog (36,4%) IKK (p = 0,007). Kombinovane hemoragije, kao i podtipovi subarahnoidna i subduralna hemoragijia, bili su češći u drugom talasu (23,1% svaki podtip). U prvom talasu, bilo je 38,1% fatalnih ishoda, u odnosu na 69,2% tokom drugog talasa (p = 0,039). Zaključak. U prvom pandemijskom talasu COVID-19, u poređenju sa drugim talasom, IKK su bile znatno češće kod CB, a u laboratorijskim analizama se izdvajao D-dimer, čije su vrednosti bile statistički značajno više. U drugom talasu COVID-19, kod CB sa IKK, parenhimalna IKK je bila manje učestala a multifokalne i difuzne IKK bile su češće. Stopa mortaliteta bila je veoma visoka u drugom talasu.

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Akutno intrakranijalno krvarenje kod 76 bolesnika obolelih od COVID-19 u prvom i drugom talasu pandemije

Sažetak

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