Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries

被引：3

作者：

Battaglini, Denise ^{[1
]}

Kelly, Thu-Lan ^{[2
]}

Griffee, Matthew ^{[3
]}

Fanning, Jonathon ^{[4
,5
]}

Premraj, Lavienraj ^{[4
,6
]}

Whitman, Glenn ^{[7
]}

Porto, Diego Bastos ^{[8
,9
,10
]}

Arora, Rakesh ^{[11
,12
,13
]}

Thomson, David ^{[13
,14
]}

Pelosi, Paolo ^{[1
]}

White, Nicole M. ^{[5
,6
,14
]}

Bassi, Gianluigi Li ^{[2
,3
,5
,6
,15
,16
,17
,18
]}

Suen, Jacky ^{[5
,6
]}

Fraser, John F. ^{[3
,6
,17
,18
,19
,20
]}

Robba, Chiara ^{[1
,2
]}

Cho, Sungmin ^{[8
,9
,10
]}

机构：

[1] IRCCS Osped Policlin San Martino, Anesthesia & Intens Care, Genoa, Italy

[2] Univ Genoa, Dept Surg Sci & Integrated Diagnost, Genoa, Italy

[3] Queensland Univ Technol, Brisbane, Australia

[4] Univ Utah, Dept Anesthesiol Perioperat & Pain Med, Salt Lake City, UT USA

[5] Univ Queensland, Fac Med, Brisbane, Qld, Australia

[6] Prince Charles Hosp, Crit Care Res Grp, Brisbane, Australia

[7] Griffith Univ, Sch Med, Gold Coast, Australia

[8] Johns Hopkins Univ, Dept Neurol, Div Neurosci Crit Care, Sch Med, Baltimore, MD USA

[9] Johns Hopkins Univ, Dept Neurosurg, Sch Med, Baltimore, MD USA

[10] Johns Hopkins Univ, Dept Anesthesiol & Crit Care Med, Sch Med, Baltimore, MD USA

[11] Univ Fed Ceara, Fac Med, Dept Clin Med, Fortaleza, Ceara, Brazil

[12] Univ Manitoba, Max Rady Coll Med, Dept Surg, Sect Cardiac Surg, Winnipeg, MB, Canada

[13] St Boniface Gen Hosp, Cardiac Sci Program, Winnipeg, MB, Canada

[14] Univ Cape Town, Div Crit Care, Cape Town, South Africa

[15] Queensland Univ Technol, Sch Publ Hlth & Social Work, Australian Ctr Hlth Serv Innovat, Ctr Healthcare Transformat, Brisbane, Qld, Australia

[16] Inst Invest Biomed August Pi & Sunyer, Barcelona, Spain

[17] Univ Queensland, Brisbane, Australia

[18] St Andrews War Mem Hosp, UnitingCare Hlth, Brisbane, Australia

[19] Wesley Med Res, Brisbane, Australia

[20] Griffith Univ, Sch Med, Brisbane, Australia

来源：

HEART & LUNG | 2024年 / 68卷

基金：

比尔及梅琳达.盖茨基金会;

关键词：

COVID-19; Neurological complications; Disability; Stroke; Income countries; CARE; COMPLICATIONS; STATEMENT;

D O I：

10.1016/j.hrtlng.2024.06.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Purpose: We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. Methods: International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. Results: 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4-44.9) LMICs and 17.6 (95 %CI = 15.8-19.7) HICs; ischemic 9.47 (95 %CI = 6.57-13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73-10.9) LMICs, and 2.52 (95 %CI = 2.00-3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75-17.3) LMICs, 8.99 (95 %CI = 7.70-10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31-2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29-2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19-1.72), p < 0.001)]. Conclusions: Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. Trial registration: ACTRN12620000421932 registered on 30/03/2020.

引用

页码：131 / 144

页数：14

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