Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
J Neurol Sci. 2024 Nov 15;466:123263. doi: 10.1016/j.jns.2024.123263. Epub 2024 Sep 30.
Stroke is a devastating complication of Sickle Cell Disease (SCD) with significant mortality and substantial morbidity. The burden of prevalent stroke in SCD is highest in sub-Saharan Africa and estimated at 4.2 % to 6.4 % in the era where evidence-based prevention strategies such as use of hydroxyurea therapy and transcranial doppler ultrasound were not routine care.
To assess the contemporary frequency and factors associated with prevalent stroke across the lifespan in an SCD registry at the tertiary medical center in Ghana.
This is a cross-sectional study conducted at the Komfo Anokye Teaching Hospital, a tertiary medical center in the middle belt of Ghana. The center has comprehensive Sickle Cell Clinics for children, adolescents, and adults with a patient registry established as part of the Sickle Pan-African Research Consortium (SPARCo)-Ghana study from 2017 to date. Data captured in the registry and analyzed for the present study include demographics, stroke status using the WHO criteria supplemented by the Questionnaire for Verifying Stroke Free Status (QVSFS), use of hydroxyurea, and complete blood count. Logistic regression modeling was utilized to assess factors associated with stroke.
Among a registry cohort of 4115 individuals with confirmed SCD, 35 (0.85 %, 95 % CI: 0.59-1.18 %) had overt or clinically confirmed stroke. The frequency of stroke differed significantly across the lifespan being 0.38 % (95 % CI: 0.12-0.64 %) among children <10 years, 1.23 % (95 % CI: 0.73-1.94 %) among adolescents aged 10 to 17 years, and 1.44 % (95 % CI: 0.66-2.71 %) among adults 18 years or more, p = 0.007. In adjusted analysis, each 10-year increase in age was associated with odds ratio, OR (95 % CI) of 1.90 (1.42-2.54) and hydroxyurea use, OR of 6.09 (2.65-13.99). The association between hydroxyurea and stroke observed in this cross-sectional study is not causal.
Approximately 1 in 120 SCD patients in this large Ghanaian cohort had clinically overt stroke. The gradual uptake of hydroxyurea therapy into routine care for SCD in this resource-limited setting, may partly explain the lower frequency of stroke.
中风是镰状细胞病（SCD）的一种严重并发症，具有显著的死亡率和较高的发病率。在证据为基础的预防策略（如使用羟基脲治疗和经颅多普勒超声）尚未常规应用的时代，撒哈拉以南非洲的 SCD 患者中，中风的现患率最高，估计为 4.2%至 6.4%。
评估加纳三级医疗中心 SCD 登记处中终生普遍存在的中风频率及其相关因素。
这是一项横断面研究，在加纳中地带的科姆福安诺耶教学医院进行。该中心设有综合性镰状细胞诊所，为儿童、青少年和成人提供服务，并于 2017 年至今建立了 Sickle Pan-African Research Consortium（SPARCo）-加纳研究的患者登记处。本研究分析了登记处中捕获的数据，包括人口统计学数据、使用世界卫生组织（WHO）标准和问卷调查表（QVSFS）确定的中风状态、使用羟基脲情况以及全血细胞计数。利用逻辑回归模型评估与中风相关的因素。
在登记处的 4115 名 SCD 患者中，有 35 名（0.85%，95%CI：0.59-1.18%）出现显性或临床确诊的中风。中风的频率在整个生命周期中存在显著差异，<10 岁的儿童中为 0.38%（95%CI：0.12-0.64%），10-17 岁的青少年中为 1.23%（95%CI：0.73-1.94%），18 岁及以上的成年人中为 1.44%（95%CI：0.66-2.71%），p=0.007。在调整分析中，年龄每增加 10 岁，比值比（OR）（95%CI）为 1.90（1.42-2.54），使用羟基脲的 OR 为 6.09（2.65-13.99）。本横断面研究中观察到的羟基脲与中风之间的关联并非因果关系。
在这个大型加纳队列中，每 120 名 SCD 患者中就有 1 名患者出现临床显性中风。在这个资源有限的环境中，羟基脲治疗逐渐被纳入 SCD 的常规治疗中，这可能部分解释了中风频率较低的原因。
