Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
Queensland University of Technology, Brisbane, Australia.
Heart Lung. 2024 Nov-Dec;68:131-144. doi: 10.1016/j.hrtlng.2024.06.015. Epub 2024 Jul 4.
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.
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.
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)].
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.
ACTRN12620000421932 registered on 30/03/2020.
我们旨在比较 COVID-19 危重症患者中低收入国家（LMICs）和高收入国家（HICs）的卒中发生率及其对住院死亡率的影响。
在 43 个国家进行的国际观察性研究。使用泊松回归计算每入院天的卒中发生率和发病率比（IRR）。采用逆概率加权（IPW）来校正 HICs 与 LMICs 之间混杂因素的不平衡。
共纳入 23738 例患者[20511 例（86.4%）HICs 与 3227 例（13.6%）LMICs]。LMICs 卒中/1000 入院天的发生率为 35.7（95%CI=28.4-44.9），HICs 为 17.6（95%CI=15.8-19.7）；缺血性卒中 9.47（95%CI=6.57-13.7）LMICs，1.97（95%CI=1.53，2.55）HICs；出血性卒中 7.18（95%CI=4.73-10.9）LMICs，2.52（95%CI=2.00-3.16）HICs；未明确类型卒中 11.6（95%CI=7.75-17.3）LMICs，8.99（95%CI=7.70-10.5）HICs。在采用 IPW 的回归分析中，LMICs 与 HICs 的 IRR=1.78（95%CI=1.31-2.42，p<0.001）。来自 LMICs 的患者比来自 HICs 的患者更有可能死亡[43.6% vs 29.2%；相对风险（RR）=2.59（95%CI=2.29-2.93），p<0.001]。患有卒中的患者比没有卒中的患者更有可能死亡[RR=1.43（95%CI=1.19-1.72），p<0.001]。
HICs 和 LMICs 的卒中发生率较低，尽管 LMICs 的卒中风险更高。LMIC 状态和卒中都增加了死亡风险。应优先考虑改善卒中的早期诊断和医疗资源的再分配。
ACTRN12620000421932 于 2020 年 3 月 30 日注册。
