Logo image
Back
Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries
Journal article   Peer reviewed

Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries

Denise Battaglini, Thu-Lan Kelly, Matthew Griffee, Jonathon Fanning, Lavienraj Premraj, Glenn Whitman, Diego Bastos Porto, Rakesh Arora, David Thomson, COVID-19 Critical Care Consortium Investigators, …
Heart & lung, Vol.68, pp.131-144
11/2024
DOI: 10.1016/j.hrtlng.2024.06.015
PMID: 38968643
url
https://research.rug.nl/en/publications/6d53e7cd-aa8c-47eb-9eb8-54d58a5246bcView
Open Access

Abstract

•Global income inequality and disparities of healthcare resources have been exacerbated by the pandemic.•Coronavirus disease-2019 (COVID-19) causes severe respiratory distress as well as a slew of additional systemic consequences that affect several organ systems, including neurological complications. Ischemic stroke represents the most common neurological complication of respiratory failure due to COVID-19.•Stroke incidence per admitted days in patients with respiratory failure due to COVID-19 was low in high income countries (HICs) and low-middle income countries (LMICs) although the stroke risk was higher in LMICs.•Both LMIC status and stroke increased the risk of death in patients with respiratory failure due to COVID-19. 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.
 Stroke COVID-19 Disability Income countries Neurological complications

Details

Metrics

7 Record Views
3 Times Cited - Web of Science
Logo image