TY - JOUR
T1 - Stroke in critically ill patients with respiratory failure due to COVID-19
T2 - Disparities between low-middle and high-income countries
AU - COVID-19 Critical Care Consortium Investigators
AU - Battaglini, Denise
AU - Kelly, Thu Lan
AU - Griffee, Matthew
AU - Fanning, Jonathon
AU - Premraj, Lavienraj
AU - Whitman, Glenn
AU - Porto, Diego Bastos
AU - Arora, Rakesh
AU - Thomson, David
AU - Pelosi, Paolo
AU - White, Nicole M.
AU - Bassi, Gianluigi Li
AU - Suen, Jacky
AU - Fraser, John F.
AU - Robba, Chiara
AU - Cho, Sung Min
AU - Al-Dabbous, Tala
AU - Alfoudri, Huda
AU - Shamsah, Mohammed
AU - Alfroukh, Khadeejeh
AU - Bairmani, Zinah Aqeel Abdulzahra
AU - Khalid, Khalid Jehad
AU - Abukhalaf, Salsabeel M.A.
AU - Hadhoud, Mohammed Maher
AU - Abdrabo, Mohamed Fouad
AU - Fathi, Mohamed
AU - Alhouri, Hasan
AU - Shahla, Dr Hamza
AU - Alhadad, Qamrah
AU - Hanan, Matly
AU - Elapavaluru, Subbarao
AU - Berg, Ashley
AU - Horn, Christina
AU - Abdelhalim, Ahmed Reda Mohamed Elsayed
AU - Amer, Amro Essam
AU - Elnaggar, Cinderella Omar Rageh
AU - Hassan, Ahmed Ayman
AU - Abdelaziz, Ali
AU - Abdelhalim, Mohamed
AU - Orabi, Yehia Samir Shaaban Aly
AU - Alaraji, Zinah A.
AU - Muhaisen, Mo'nes R.
AU - Almasri, Lana
AU - Mustafa, Dana
AU - Hamdan, Shaher
AU - Al-Saba'a, Yousef
AU - Dalloul, Zaina
AU - Alkahlout, Mohammed
AU - Jaber, Hamza
AU - Aldabbourosama, Osama
AU - Abdalhadi, Alaa Abdalfattah
AU - Hussein, Aliae AR Mohamed
AU - Emad, Zarief Kamel
AU - Khaled, Sarah
AU - Mohamed, Nouralsabah
AU - Hassanin, Ebtisam
AU - Hamdi, Abdelhafeez
AU - Gamal, May
AU - Emad, Ahmed
AU - Ragab, Abdelrahman
AU - Azizeldin, Mohammed G.
AU - Hamza, Almthani
AU - Omer, Alsarrah Ali Mohammed
AU - Fadl alla, Asgad Osman Abdalla
AU - Abdallahrs, Asia Atif Abdelrahman
AU - Eltayeb, Aml Ahmed
AU - Alhasan, Maali khalid mohamed abdalla
AU - Abdelgaum, Esraa Hassan
AU - Ahmed, Aya Mustafa
AU - Abdulbaqi, Lamees Adil
AU - Mohammedelhassan, Omer Abdullah
AU - Ahmed, Musaab Mohammed Mohammed
AU - Ali, Maha Tag Elser Mohammed
AU - Mayasi, Yunis
AU - Schroll, Stephan
AU - Meyer, Dan
AU - Velazco, Jorge
AU - Ploskanych, Ludmyla
AU - Fikes, Wanda
AU - Bagewadi, Rohini
AU - Dao, Marvin
AU - White, Haley
AU - Laviena, Alondra Berrios
AU - Ehlers, Ashley
AU - Shalabi-McGuire, Maysoon
AU - Witt, Trent
AU - Grazioli, Lorenzo
AU - Lorini, Luca
AU - Grandin, E. Wilson
AU - Nunez, Jose
AU - Reyes, Tiago
AU - O'Briain, Diarmuid
AU - Hunter, Stephanie
AU - Ramanan, Mahesh
AU - Affleck, Julia
AU - Veerendra, Hemanth Hurkadli
AU - Rai, Sumeet
AU - Russell-Brown, Josie
AU - Nourse, Mary
AU - Laffey, John
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/11/1
Y1 - 2024/11/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - Disability
KW - Income countries
KW - Neurological complications
KW - Stroke
KW - Humans
KW - COVID-19/epidemiology
KW - Female
KW - Male
KW - Stroke/epidemiology
KW - Developing Countries/statistics & numerical data
KW - Critical Illness/epidemiology
KW - Middle Aged
KW - Developed Countries/statistics & numerical data
KW - Hospital Mortality/trends
KW - Incidence
KW - Aged
KW - Respiratory Insufficiency/epidemiology
KW - SARS-CoV-2
UR - https://www.scopus.com/pages/publications/85197512084
U2 - 10.1016/j.hrtlng.2024.06.015
DO - 10.1016/j.hrtlng.2024.06.015
M3 - Article
C2 - 38968643
AN - SCOPUS:85197512084
SN - 0147-9563
VL - 68
SP - 131
EP - 144
JO - Heart and Lung
JF - Heart and Lung
ER -
SDG 3 Good Health and Well-being