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.