Abstract
Background and purpose: During the COVID-19 outbreak, the presence of extensive white matter microhemorrhages was detected by brain MRIs. The goal of this study was to investigate the origin of this atypical hemorrhagic complication.
Methods: Between March 17 and May 18, 2020, 80 patients with severe COVID-19 infections were admitted for acute respiratory distress syndrome to intensive care units at the University Hospitals of Strasbourg for whom a brain MRI for neurologic manifestations was performed. 19 patients (24%) with diffuse microhemorrhages were compared to 18 control patients with COVID-19 and normal brain MRI.
Results: The first hypothesis was hypoxemia. The latter seemed very likely since respiratory failure was longer and more pronounced in patients with microhemorrhages (prolonged endotracheal intubation (p = 0.0002), higher FiO 2 (p = 0.03), increased use of extracorporeal membrane oxygenation (p = 0.04)). A relevant hypothesis, the role of microangiopathy, was also considered, since patients with microhemorrhages presented a higher increase of the D-Dimers (p = 0.01) and a tendency to more frequent thrombotic events (p = 0.12). Another hypothesis tested was the role of kidney failure, which was more severe in the group with diffuse microhemorrhages (higher creatinine level [median of 293 µmol/L versus 112 µmol/L, p = 0.04] and more dialysis were introduced in this group during ICU stay [12 versus 5 patients, p = 0.04]).
Conclusions: Blood-brain barrier dysfunction secondary to hypoxemia and high concentration of uremic toxins seems to be the main mechanism leading to critical illness-associated cerebral microbleeds, and this complication remains to be frequently described in severe COVID-19 patients.
Keywords: COVID-19; Hypoxemia; Kidney failure; MRI; Microhemorrhages.
【저자키워드】 COVID-19, MRI, Hypoxemia, Kidney failure, Microhemorrhages., 【초록키워드】 Respiratory distress syndrome, Critical illness, Respiratory failure, acute respiratory distress syndrome, intensive care unit, Brain, ICU, dialysis, kidney, extracorporeal membrane oxygenation, intensive care units, COVID-19 outbreak, Hypoxemia, Patient, blood-brain barrier, D-dimers, university, Critical, patients, mechanism, acute respiratory distress, Hypothesis, creatinine, Concentration, Atypical, Kidney failure, manifestation, microangiopathy, Endotracheal intubation, respiratory distress, secondary to, brain MRI, dysfunction, Hemorrhagic, Severe COVID-19 Infection, White matter, COVID-19 infections, syndrome, severe COVID-19 patients, thrombotic, severe COVID-19 infections, toxin, tendency, neurologic, thrombotic event, tested, described, was performed, introduced, control patient, uremic, with COVID-19, 【제목키워드】 Patient, hypothese,