Cerebral venous sinus thrombosis in patients with COVID-19

ABSTRACT

Background: Because COVID-19 is thought to be pro-thrombotic and could theoretically increase the severity of cerebral venous sinus thrombosis (CVST), we sought to examine the outcomes of CVST patients with comorbid COVID-19 infection. Methods: We performed a retrospective analysis using the Vizient Clinical Data Base (CDB), a healthcare analytics platform employed by participating US hospitals. We identified CVST with the ICD-10 codes I63.6, I67.6, G08.x, O22.5, and O87.3. We created three cohorts of patients CVST with confirmed or suspected COVID-19 in April, May or June 2020, CVST with influenza-like illness (ILI) in 2019, and CVST without ILI in 2019. The outcomes are 1) in-hospital death and 2) favorable discharge (discharge destination home or acute rehabilitation). We fit logistic regression models to our outcomes and adjusted for patient age, sex, race/ethnicity, Elixhauser comorbidity score, acute respiratory failure requiring intubation, and hospital length of stay. Results: We identified 73 patients with CVST and COVID-19, 159 with CVST and ILI, and 4,146 with CVST and no COVID-19 or ILI. The patient death rates were 20.6%, 8.8%, and 5.1%, respectively, and favorable discharge rates were 58.9%, 52.8%, and 77.3%, respectively. Compared to CVST patients with ILI, those with COVID-19 were not significantly more likely to die in-hospital (adjusted OR 1.43, 95% CI 0.44-4.66, p=0.557) or to have favorable discharge (adjusted OR 1.75, 95% CI 0.58-5.25, p=0.321). Compared to CVST patients without ILI or COVID-19, those with COVID-19 were also not significantly more likely to die in-hospital (adjusted OR 0.87, 95% CI 0.35- 2.12, p=0.751) or to have favorable discharge (adjusted OR 1.52, 95% CI 0.62-3.69, p=0.358). Conclusion: Although CVST patients with COVID-19 had a higher in-hospital death rate and lower favorable discharge rates, after adjusting for potential confounders there was no association between worse outcomes in CVST patients with COVID-19. This suggests that while CVST may complicate COVID-19, it does not portend a worse prognosis than CVST in patients with either ILI or no ILI or COVID-19.