Subarachnoid Hemorrhage and Coronavirus Disease 2019: An Analysis of 282,718 Patients

Qureshi, Adnan I.; Baskett, William I.; Huang, Wei; Shyu, Daniel; Myers, Danny; Lobanova, Iryna; Ishfaq, Muhammad F.; Naqvi, S. Hasan; French, Brandi R.; Siddiq, Farhan; Gomez, Camilo R.; Shyu, Chi-Ren

Background Intracranial hemorrhage (including subarachnoid hemorrhage) has been reported in 0.3 to 1.2% of patients with coronavirus disease 2019 (COVID-19). However, no study has evaluated the risk of subarachnoid hemorrhage in COVID-19 patients. Methods We analyzed the data from 62 healthcare facilities using the Cerner de-identified COVID-19 dataset. Results A total of 86 (0.1%) and 376 (0.2%) subarachnoid hemorrhage patients among 85,645 patients with COVID-19 and 197,073 patients without COVID-19, respectively. In the multivariate model, there was a lower risk of subarachnoid hemorrhage in COVID-19 patients (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.4-0.7, p<.0001) after adjusting for gender, age strata, race, hypertension and nicotine dependence/tobacco use. The proportions of patients who developed pneumonia (58.1% versus 21.3%, p<.0001), acute kidney injury (43% versus 27.7%, p=0.0005), septic shock (44.2% versus 20.7%, p<.0001) and respiratory failure (64.0% versus 39.1%, p<.0001) were significantly higher among subarachnoid hemorrhage patients with COVID-19 compared with those without COVID-19. The in-hospital mortality among subarachnoid hemorrhage patients with COVID-19 was significantly higher compared with those without COVID-19 (31.4% versus 12.2%, p<.0001). Conclusion The risk of subarachnoid hemorrhage was not increased in patients with COVID-19. The higher mortality in subarachnoid hemorrhage patients with COVID-19 compared with those without COVID-19 is likely mediated by higher frequency of systemic co-morbidities.