Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries. Heart Lung 2024;68:131-144
Date
07/06/2024Pubmed ID
38968643DOI
10.1016/j.hrtlng.2024.06.015Scopus ID
2-s2.0-85197512084 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
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.
Author List
Battaglini D, Kelly TL, Griffee M, Fanning J, Premraj L, Whitman G, Porto DB, Arora R, Thomson D, Pelosi P, White NM, Bassi GL, Suen J, Fraser JF, Robba C, Cho SM, COVID-19 Critical Care Consortium InvestigatorsAuthor
Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedCritical Illness
Developed Countries
Developing Countries
Female
Hospital Mortality
Humans
Incidence
Male
Middle Aged
Respiratory Insufficiency
Stroke