CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
PeerJ. 2022 Nov 25;10:e14467. doi: 10.7717/peerj.14467. eCollection 2022.
Peru faces challenges to provide adequate care to stroke patients. Length of hospitalization and in-hospital mortality are two well-known indicators of stroke care. We aimed to describe the length of stay (LOS) of stroke in Peru, and to assess in-hospital mortality risk due to stroke, and subtypes.
This retrospective cohort study used hospitalization registries coding with ICD-10 from 2002 to 2017 ( = 98,605) provided by the Ministry of Health; in-hospital mortality was available for 2016-2017 ( = 6,566). Stroke cases aged ≥35 years were divided into subarachnoid hemorrhage (I60), intracerebral hemorrhage (I61), cerebral infarction (I63), and stroke not specified as hemorrhage or infarction (I64). Data included stroke LOS and in-hospital mortality; socio-demographic and clinical variables. We fitted a region- and hospital level-stratified Weibull proportional hazard model to assess the in-hospital mortality.
The median LOS was 7 days (IQR: 4-13). Hemorrhagic strokes had median LOS longer than ischemic strokes and stroke not specified as hemorrhage or infarction ( = <0.001). The case fatality rate (CFR) of patients with stroke was 11.5% (95% CI [10-12%]). Subarachnoid hemorrhage (HR = 2.45; 95% CI [1.91-3.14]), intracerebral hemorrhage (HR = 1.95; 95% CI [1.55-2.46]), and stroke not specified as hemorrhage or infarction (HR = 1.45; 95% CI [1.16-1.81]) were associated with higher in-hospital mortality risk in comparison to ischemic strokes.
Between 2002 and 2017, LOS due to stroke has not changed in Peru in stroke patients discharged alive. Hemorrhagic cases had the longest LOS and highest in-hospital mortality risk during 2016 and 2017. The findings of our study seem to be consistent with a previous study carried out in Peru and similar to that of HIC and LMIC, also there is an increased median LOS in stroke cases managed in specialized centers. Likewise, LOS seems to depend on the type of stroke, where ischemic stroke cases have the lowest LOS. Peru needs to improve access to stroke care.
秘鲁在为脑卒中患者提供充分治疗方面面临挑战。住院时间和院内死亡率是两个众所周知的脑卒中治疗指标。我们旨在描述秘鲁脑卒中患者的住院时间，并评估因脑卒中及亚型导致的院内死亡率风险。
本回顾性队列研究使用了卫生部提供的 2002 年至 2017 年（=98605）国际疾病分类第十次修订版（ICD-10）编码的住院记录；2016 年至 2017 年可获得院内死亡率（=6566）。年龄≥35 岁的脑卒中患者分为蛛网膜下腔出血（I60）、脑实质内出血（I61）、脑梗死（I63）和未特指为出血或梗死的脑卒中（I64）。数据包括脑卒中的住院时间和院内死亡率，以及社会人口统计学和临床变量。我们使用区域和医院水平分层威布尔比例风险模型评估院内死亡率。
中位数住院时间为 7 天（IQR：4-13）。出血性脑卒中的中位数住院时间长于缺血性脑卒中及未特指为出血或梗死的脑卒中（P<0.001）。脑卒中患者的病死率（CFR）为 11.5%（95%CI[10-12%]）。与缺血性脑卒中相比，蛛网膜下腔出血（HR=2.45；95%CI[1.91-3.14]）、脑实质内出血（HR=1.95；95%CI[1.55-2.46]）和未特指为出血或梗死的脑卒中（HR=1.45；95%CI[1.16-1.81]）与更高的院内死亡率风险相关。
在 2002 年至 2017 年期间，秘鲁存活出院的脑卒中患者的住院时间未发生变化。2016 年和 2017 年，出血性脑卒中的住院时间最长，院内死亡率风险最高。本研究的结果似乎与秘鲁之前的一项研究一致，也与高收入国家和中低收入国家的研究结果一致，即专门中心治疗的脑卒中患者的中位住院时间有所增加。同样，住院时间似乎取决于脑卒中的类型，其中缺血性脑卒中的住院时间最短。秘鲁需要改善脑卒中治疗的可及性。
