Denise Battaglini MD, PhD , Thu-Lan Kelly PhD , Matthew Griffee MD, PhD , Jonathon Fanning MD, PhD , Lavienraj Premraj Ms , Glenn Whitman MD , Diego Bastos Porto MD, PhD , Rakesh Arora MD, PhD , David Thomson MD, PhD , Paolo Pelosi MD, FERS, FESAIC , Nicole M. White PhD , Gianluigi Li Bassi MD, PhD , Jacky Suen MD, PhD , John F. Fraser MD, PhD , Chiara Robba MD, PhD , Sung-Min Cho DO, MHS
{"title":"COVID-19导致呼吸衰竭的重症患者中风：中低收入国家与高收入国家之间的差距。","authors":"Denise Battaglini MD, PhD , Thu-Lan Kelly PhD , Matthew Griffee MD, PhD , Jonathon Fanning MD, PhD , Lavienraj Premraj Ms , Glenn Whitman MD , Diego Bastos Porto MD, PhD , Rakesh Arora MD, PhD , David Thomson MD, PhD , Paolo Pelosi MD, FERS, FESAIC , Nicole M. White PhD , Gianluigi Li Bassi MD, PhD , Jacky Suen MD, PhD , John F. Fraser MD, PhD , Chiara Robba MD, PhD , Sung-Min Cho DO, MHS","doi":"10.1016/j.hrtlng.2024.06.015","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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, <em>p</em> < 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), <em>p</em> < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), <em>p</em> < 0.001)].</p></div><div><h3>Conclusions</h3><p>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.</p></div><div><h3>Trial registration</h3><p>ACTRN12620000421932 registered on 30/03/2020.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries\",\"authors\":\"Denise Battaglini MD, PhD , Thu-Lan Kelly PhD , Matthew Griffee MD, PhD , Jonathon Fanning MD, PhD , Lavienraj Premraj Ms , Glenn Whitman MD , Diego Bastos Porto MD, PhD , Rakesh Arora MD, PhD , David Thomson MD, PhD , Paolo Pelosi MD, FERS, FESAIC , Nicole M. White PhD , Gianluigi Li Bassi MD, PhD , Jacky Suen MD, PhD , John F. Fraser MD, PhD , Chiara Robba MD, PhD , Sung-Min Cho DO, MHS\",\"doi\":\"10.1016/j.hrtlng.2024.06.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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, <em>p</em> < 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), <em>p</em> < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), <em>p</em> < 0.001)].</p></div><div><h3>Conclusions</h3><p>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.</p></div><div><h3>Trial registration</h3><p>ACTRN12620000421932 registered on 30/03/2020.</p></div>\",\"PeriodicalId\":55064,\"journal\":{\"name\":\"Heart & Lung\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-07-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart & Lung\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0147956324001237\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart & Lung","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0147956324001237","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries
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.
期刊介绍：
Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders.
The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.
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