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; Paolo Pelosi; Nicole M. White; Gianluigi Li Bassi; Jacky Suen; John F. Fraser; Chiara Robba; Sung Min Cho; Tala Al-Dabbous; Huda Alfoudri; Mohammed Shamsah; Khadeejeh Alfroukh; Zinah Aqeel Abdulzahra Bairmani; Khalid Jehad Khalid; Salsabeel M.A. Abukhalaf; Mohammed Maher Hadhoud; Mohamed Fouad Abdrabo; Mohamed Fathi; Hasan Alhouri; Dr Hamza Shahla; Qamrah Alhadad; Matly Hanan; Subbarao Elapavaluru; Ashley Berg; Christina Horn; Ahmed Reda Mohamed Elsayed Abdelhalim; Amro Essam Amer; Cinderella Omar Rageh Elnaggar; Ahmed Ayman Hassan; Ali Abdelaziz; Mohamed Abdelhalim; Yehia Samir Shaaban Aly Orabi; Zinah A. Alaraji; Mo'nes R. Muhaisen; Lana Almasri; Dana Mustafa; Shaher Hamdan; Yousef Al-Saba'a; Zaina Dalloul; Mohammed Alkahlout; Hamza Jaber; Osama Aldabbourosama; COVID-19 Critical Care Consortium Investigators; Roberto Lorusso; Bas van Bussel; Maria E. de Piero; Silvia Mariani

doi:10.1016/j.hrtlng.2024.06.015

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, Paolo Pelosi, Nicole M. White, Gianluigi Li Bassi, Jacky Suen, John F. Fraser, Chiara Robba, Sung Min Cho, Tala Al-Dabbous, Huda Alfoudri, Mohammed Shamsah, Khadeejeh AlfroukhZinah Aqeel Abdulzahra Bairmani, Khalid Jehad Khalid, Salsabeel M.A. Abukhalaf, Mohammed Maher Hadhoud, Mohamed Fouad Abdrabo, Mohamed Fathi, Hasan Alhouri, Dr Hamza Shahla, Qamrah Alhadad, Matly Hanan, Subbarao Elapavaluru, Ashley Berg, Christina Horn, Ahmed Reda Mohamed Elsayed Abdelhalim, Amro Essam Amer, Cinderella Omar Rageh Elnaggar, Ahmed Ayman Hassan, Ali Abdelaziz, Mohamed Abdelhalim, Yehia Samir Shaaban Aly Orabi, Zinah A. Alaraji, Mo'nes R. Muhaisen, Lana Almasri, Dana Mustafa, Shaher Hamdan, Yousef Al-Saba'a, Zaina Dalloul, Mohammed Alkahlout, Hamza Jaber, Osama Aldabbourosama, COVID-19 Critical Care Consortium Investigators, Roberto Lorusso, Bas van Bussel, Maria E. de Piero, Silvia Mariani

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Pages (from-to)	131-144
Number of pages	14
Journal	Heart & Lung
Volume	68
DOIs	https://doi.org/10.1016/j.hrtlng.2024.06.015
Publication status	Published - 1 Nov 2024

Keywords

COVID-19
Disability
Income countries
Neurological complications
Stroke

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10.1016/j.hrtlng.2024.06.015

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Battaglini, D., Kelly, T. L., Griffee, M., Fanning, J., Premraj, L., Whitman, G., Porto, D. B., Arora, R., Thomson, D., Pelosi, P., White, N. M., Bassi, G. L., Suen, J., Fraser, J. F., Robba, C., Cho, S. M., Al-Dabbous, T., Alfoudri, H., Shamsah, M., ... Mariani, S. (2024). Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries. Heart & Lung, 68, 131-144. https://doi.org/10.1016/j.hrtlng.2024.06.015

@article{865c16c652eb48ea8bb57b323a685ee8,

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

abstract = "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.",

keywords = "COVID-19, Disability, Income countries, Neurological complications, Stroke",

author = "Denise Battaglini and Kelly, {Thu Lan} and Matthew Griffee and Jonathon Fanning and Lavienraj Premraj and Glenn Whitman and Porto, {Diego Bastos} and Rakesh Arora and David Thomson and Paolo Pelosi and White, {Nicole M.} and Bassi, {Gianluigi Li} and Jacky Suen and Fraser, {John F.} and Chiara Robba and Cho, {Sung Min} and Tala Al-Dabbous and Huda Alfoudri and Mohammed Shamsah and Khadeejeh Alfroukh and Bairmani, {Zinah Aqeel Abdulzahra} and Khalid, {Khalid Jehad} and Abukhalaf, {Salsabeel M.A.} and Hadhoud, {Mohammed Maher} and Abdrabo, {Mohamed Fouad} and Mohamed Fathi and Hasan Alhouri and Shahla, {Dr Hamza} and Qamrah Alhadad and Matly Hanan and Subbarao Elapavaluru and Ashley Berg and Christina Horn and Abdelhalim, {Ahmed Reda Mohamed Elsayed} and Amer, {Amro Essam} and Elnaggar, {Cinderella Omar Rageh} and Hassan, {Ahmed Ayman} and Ali Abdelaziz and Mohamed Abdelhalim and Orabi, {Yehia Samir Shaaban Aly} and Alaraji, {Zinah A.} and Muhaisen, {Mo'nes R.} and Lana Almasri and Dana Mustafa and Shaher Hamdan and Yousef Al-Saba'a and Zaina Dalloul and Mohammed Alkahlout and Hamza Jaber and Osama Aldabbourosama and {COVID-19 Critical Care Consortium Investigators} and Roberto Lorusso and {van Bussel}, Bas and {de Piero}, {Maria E.} and Silvia Mariani",

note = "Funding Information: The Bill & Melinda Gates Foundation , Grant number INV-034765 ; Queensland Health; The Prince Charles Hospital Foundation; The Wesley Medical Research; Fisher & Paykel Healthcare; The University of Queensland; The Health Research Board of Ireland. Jacky Y Suen is funded by the Advance Queensland fellowship program, Queensland Government, Australia. Gianluigi Li Bassi is a recipient of the BITRECS fellowship; the \u201CBITRECS\u201D project has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Sk\u0142odowska-Curie grant agreement no. 754550 and from the \u201CLa Caixa\u201D Foundation (ID 100010434 ), under the agreement LCF/PR/GN18/50310006. Publisher Copyright: {\textcopyright} 2024 Elsevier Inc.",

year = "2024",

month = nov,

day = "1",

doi = "10.1016/j.hrtlng.2024.06.015",

language = "English",

volume = "68",

pages = "131--144",

journal = "Heart & Lung",

issn = "0147-9563",

publisher = "Mosby Inc.",

}

Battaglini, D, Kelly, TL, Griffee, M, Fanning, J, Premraj, L, Whitman, G, Porto, DB, Arora, R, Thomson, D, Pelosi, P, White, NM, Bassi, GL, Suen, J, Fraser, JF, Robba, C, Cho, SM, Al-Dabbous, T, Alfoudri, H, Shamsah, M, Alfroukh, K, Bairmani, ZAA, Khalid, KJ, Abukhalaf, SMA, Hadhoud, MM, Abdrabo, MF, Fathi, M, Alhouri, H, Shahla, DH, Alhadad, Q, Hanan, M, Elapavaluru, S, Berg, A, Horn, C, Abdelhalim, ARME, Amer, AE, Elnaggar, COR, Hassan, AA, Abdelaziz, A, Abdelhalim, M, Orabi, YSSA, Alaraji, ZA, Muhaisen, MR, Almasri, L, Mustafa, D, Hamdan, S, Al-Saba'a, Y, Dalloul, Z, Alkahlout, M, Jaber, H, Aldabbourosama, O, COVID-19 Critical Care Consortium Investigators, Lorusso, R , van Bussel, B, de Piero, ME & Mariani, S 2024, 'Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries', Heart & Lung, vol. 68, pp. 131-144. https://doi.org/10.1016/j.hrtlng.2024.06.015

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 - 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 - COVID-19 Critical Care Consortium Investigators

AU - Lorusso, Roberto

AU - van Bussel, Bas

AU - de Piero, Maria E.

AU - Mariani, Silvia

N1 - Funding Information: The Bill & Melinda Gates Foundation , Grant number INV-034765 ; Queensland Health; The Prince Charles Hospital Foundation; The Wesley Medical Research; Fisher & Paykel Healthcare; The University of Queensland; The Health Research Board of Ireland. Jacky Y Suen is funded by the Advance Queensland fellowship program, Queensland Government, Australia. Gianluigi Li Bassi is a recipient of the BITRECS fellowship; the \u201CBITRECS\u201D project has received funding from the European Union's Horizon 2020 research and innovation program under the Marie Sk\u0142odowska-Curie grant agreement no. 754550 and from the \u201CLa Caixa\u201D Foundation (ID 100010434 ), under the agreement LCF/PR/GN18/50310006. 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

U2 - 10.1016/j.hrtlng.2024.06.015

DO - 10.1016/j.hrtlng.2024.06.015

M3 - Article

SN - 0147-9563

VL - 68

SP - 131

EP - 144

JO - Heart & Lung

JF - Heart & Lung

ER -

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

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Keywords

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