Discussion
From December, 2019, outbreak of COVID-19 infection has had a major impact on the occurrence, development and treatment of cerebrovascular diseases1.Currently, Delta and other variants are driving some countries to reinstate strict public health social. Our study has found that during COVID-19 pandemic, patients with ICH were more likely to be older, and have higher blood pressure, bigger hematoma volume, and increased risk of 3-month poor outcome and mortality.
The global burden of ICH is related to the inadequate management of chronic hypertension and other modifiable risk factors6. In China, nearly half of the adults aged between 35-75 have hypertension, but only 30.1% of hypertensive patients are being treated while about 7.2% are under control7. During COVID-19 pandemic, the situation was worse, and the higher blood pressure in ICH patients could be attributed to the social pressure, anxiety, depressed economy, lack of public health resources, inadequate control of risk factors and people’s unwillingness to seek medical treatment during this special period. Furthermore, the use of ACEI/ARBs might increase the risk of COVID-19 infection theoretically, though recent reports did not find any correlation between the discontinuation of ACEI/ARB in COVID-19 patients and severity of COVID-193, 4. For the fear of infection of COVID-19, patents may discontinue the use of ACEI/ARB.
Our study found that more ICH people went to hospitals directly without calling an ambulance. We speculated that this phenomenon was related to limited public medical resources, and anxiety.
Most important of all, our study found that ICH patients demonstrated higher NIHSS score on admission and larger hemorrhage volume. They also needed more ICU intervention and had more poor outcomes and mortality at 3 months. This finding indicated that ICH was more severe during COVID-19 pandemic, which could be related to their higher blood pressure on admission that may lead to a larger hematoma and poor prognosis. Our results were consistent with the studies reported there poor predictors of mortality: older age, larger ICH volume8.
One main limitation of our study was that we only included hospitalized patients. Those who were treated in the outpatient setting and died before reaching the hospital were not included. In addition, this study did not contain COVID-19 infected patients.
A major strength of this study is the use of CHEERY study and its consecutive enrollment of patients within a defined study time including the year before and after COVID-19 outbreak. This excludes relevant selection bias and ensures that results from this cohort are fairly representative.
Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. The medical workers may pay more attention on patients with ICH, while the public should pay more attention on hypertension control and ICH prevention.