A multicenter retrospective study on the predictive value of coronavirus disease 2019 on the short-term poor prognosis in patients with cerebral hemorrhage complicated with pulmonary infection
Objective To analyze the impact of coronavirus disease 2019 on the short-term prognosis of patients with cerebral hemorrhage complicated with pulmonary infection and its predictive efficacy.Methods We retrospectively included patients with cerebral hemorrhage complicated with pulmonary infection who were hospitalized in Affiliated Hospital of Guizhou Medical University,the Second Affiliated Hospital of Guizhou Medical University,Baiyun Hospital Affiliated to Guizhou Medical University,Wudang Hospital Affiliated to Guizhou Medical University,Jinyang Hospital Affiliated to Guizhou Medical University,Guiyang First People's Hospital,the People's Hospital of Liupanshui City,and Beijing Anzhen Hospital Affiliated to Capital Medical University from December 2020 to December 2023.There were a total of 155 patients with 86,13,6,4,26,5,14 and 1 patients in each center.The patients were divided into two groups based on the presence of coronavirus disease 2019:the positive group(patients with cerebral hemorrhage complicated with pulmonary infection and coronavirus disease 2019)and the negative group(patients with cerebral hemorrhage complicated with pulmonary infection and without coronavirus disease 2019).The patients were further divided into two groups based on the modified Rankin scale(mRS)score at 2 weeks after admission:the good prognosis group(mRS score≤3 scores)and the poor prognosis group(mRS score＞3 scores).Demographic data(age,gender),past history(hypertension,diabetes mellitus),personal history(smoking history)and clinical data such as the National Institutes of Health stroke scale(NIHSS)score and Glasgow coma scale(GCS)score at admission,amount of bleeding,cerebral herniation formation,hematoma rule,clinical test indicators(white blood cell count,neutrophil,lymphocyte,monocyte,platelet count,C reactive protein,neutrophil to lymphocyte ratio[NLR],platelet-to-lymphocyte ratio[PLR],creatinine,urea,alanine aminotransferase,aspartate aminotransferase,prothrombin time,activated partial thromboplastin time),coronavirus disease 2019 condition,head CT and chest CT,mechanical ventilation or not,surgical treatment,antiviral treatment,sepsis incidence,NIHSS score at discharge,GCS score at discharge,mRS score at 2 weeks of admission and other indicators.Logistic regression analysis was used to identify independent risk factors for poor short-term prognosis in patients with cerebral hemorrhage complicated with pulmonary infection,and receiver operating characteristic(ROC)curves were used to evaluate the predictive efficacy of these risk factors.Results(1)Compared with the negative group,the positive group had higher NIHSS scores at admission,lower lymphocyte counts,higher C reactive protein levels,higher NLR and PLR,higher mRS scores at 2 weeks after admission,a higher proportion of patients receiving mechanical ventilation,and higher antiviral treatment,with statistically significant differences(all P＜0.05).(2)Compared with the good prognosis group,the poor prognosis group had significantly higher proportions of patients with cerebral herniation(25.5％[13/51]vs.1.9％[2/104])and coronavirus disease 2019(62.7％[32/51]vs.31.7％[33/104],both P＜0.01.The poor prognosis group also had higher NIHSS scores at admission(median score:34[15,40]vs.8[4,11]),lower GCS scores at admission(9[5,12]vs.14[12,15]),higher urea levels(5.90[4.50,7.01]mmol/L vs.4.90[4.10,5.86]mmol/L,P=0.028),higher rates of sepsis(13.7％[7/51]vs.0),and a higher proportion of patients receiving mechanical ventilation(58.8％[30/51]vs.6.8％[7/104],all P＜0.01.The poor prognosis group also had higher NIHSS scores at discharge(median score:14.00[10.75,21.00]vs.3.00[0.00,6.00])and lower GCS scores at discharge(12[10,14]vs.15[15,15]),both P＜0.01.(3)Logistic regression analysis showed that coronavirus disease 2019(OR[95％CI]:4.041[1.264-12.920],P=0.019),the use of mechanical ventilation(OR[95％CI]:9.116[2.467-33.683],P=0.001),and high NIHSS scores at admission(OR[95％CI]:1.118[1.015-1.231],P=0.023)were independent risk factors for poor prognosis in patients with cerebral hemorrhage complicated with pulmonary infection.The area under the ROC curve of coronavirus disease 2019 for predicting poor prognosis in patients with cerebral hemorrhage complicated with pulmonary infection was 0.663,with sensitivity and specificity of 64.0％and 68.6％,respectively.The area under the ROC curve of mechanical ventilation support for predicting poor prognosis in patients with cerebral hemorrhage complicated with pulmonary infection was 0.766,with sensitivity and specificity of 60.0％and 93.1％,respectively.The area under the ROC curve of coronavirus disease 2019 and mechanical ventilation support was 0.825,with sensitivity and specificity of 60.0％and 93.1％,respectively.Conclusion The coronavirus disease 2019 and the application of mechanical ventilation support are independent risk factors for poor short-term prognosis in patients with cerebral hemorrhage complicated with pulmonary infection,which need to be further verified by large-sample,multi-center studies.
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