Stroke in Sierra Leone: Case fatality rate and functional outcome after stroke in Freetown.
Stroke in Sierra Leone: Case fatality rate and functional outcome after stroke in Freetown.
复制标题
DOI：
10.1177/17474930231164892
复制
发表时间：
2023-07
影响因子：
6.7
通讯作者：
Sackley, Catherine M.
中科院分区：
文献类型：
--
作者：
Youkee, Daniel;Deen, Gibrilla F.;Baldeh, Mamadu;Conteh, Zainab F.;Fox-Rushby, Julia;Gbessay, Musa;Johnson, Jotham;Langhorne, Peter;Leather, Andrew J. M.;Lisk, Durodami R.;Marshall, Iain J.;O'Hara, Jessica;Pessima, Sahr;Rudd, Anthony;Soley-Bori, Marina;Thompson, Melvina;Wafa, Hatem;Wang, Yanzhong;Watkins, Caroline L.;Williams, Christine E.;Wolfe, Charles D. A.;Sackley, Catherine M.
关于撒哈拉以南非洲（SSA）卒中后长期结局的信息有限。目前对SSA病死率（CFR）的估计是基于不同研究设计和报告异质性结果的小样本量。我们报告了来自塞拉利昂的一个大型、前瞻性、纵向卒中患者队列的CFR和功能结局，并描述了与死亡率和功能结局相关的因素。塞拉利昂弗里敦的两家成人三级政府医院建立了前瞻性纵向中风登记册。它招募了所有18岁以上的中风患者，使用世界卫生组织的定义，从2019年5月到2021年10月。为了减少对登记册的选择偏见，所有调查都由资助者支付费用，并进行宣传以提高对研究的认识。在所有患者入院时、卒中后7天、90天、1年和2年收集社会人口学数据、美国国立卫生研究院卒中量表（NIHSS）和Barthel指数（BI）。构建考克斯比例风险模型以确定与全因死亡率相关的因素。二项逻辑回归模型报告了1年时功能独立性的比值比（OR）。共纳入986例卒中患者，其中857例（87%）接受了神经影像学检查。1年随访率为82%，大多数变量的缺失项目数据<1%。卒中病例按性别平均分配，平均年龄为58.9岁（SD：14.0）。约625例（63%）为缺血性，206例（21%）为原发性脑出血，25例（3%）为蛛网膜下腔出血，130例（13%）为未确定的卒中类型。中位NIHSS为16（9-24）。30天、90天、1年和2年时的CFR分别为37%、44%、49%和53%。在任何时间点与死亡率增加相关的因素是男性（风险比（HR）：1.28（1.05-1.56）），前一次中风（HR：1.34（1.04-1.71）），房颤（HR：1.58（1.06-2.34））、蛛网膜下腔出血（HR：2.31（1.40-3.81））、未确定的卒中类型（HR：3.18（2.44-4.14））和院内并发症（HR：1.65（1.36-1.98））。大约93%的患者在中风前完全独立，在中风后1年下降到19%。功能改善最有可能发生在卒中后7 - 90天，35%的患者改善，13%的患者在90天至1年内改善。年龄增长（或：0.97（0.95-0.99））、既往卒中（OR：0.50（0.26-0.98））、NIHSS（OR：0.89（0.86-0.91））、未确定的卒中类型（OR：0.18（0.05-0.62））和101例院内并发症（OR：0.52（0.34-0.80））与1年时功能独立性的较低OR相关。高血压（OR：1.98（1.14-3.44））和家庭的主要养家糊口者（OR：1.59（1.01-2.49））与1岁时的功能独立相关。中风影响年轻人，导致死亡率和功能障碍率高于全球平均水平。降低死亡率的关键临床优先事项包括通过循证卒中护理预防卒中相关并发症，改善房颤的检测和管理，以及增加二级预防的覆盖面。应优先考虑进一步研究护理途径和干预措施，以鼓励为不太严重的中风寻求护理，包括减少中风调查和护理的成本障碍。
There is limited information on long-term outcomes after stroke in sub-Saharan Africa (SSA). Current estimates of case fatality rate (CFR) in SSA are based on small sample sizes with varying study design and report heterogeneous results. We report CFR and functional outcomes from a large, prospective, longitudinal cohort of stroke patients in Sierra Leone and describe factors associated with mortality and functional outcome. A prospective longitudinal stroke register was established at both adult tertiary government hospitals in Freetown, Sierra Leone. It recruited all patients ⩾ 18 years with stroke, using the World Health Organization definition, from May 2019 until October 2021. To reduce selection bias onto the register, all investigations were paid by the funder and outreach conducted to raise awareness of the study. Sociodemographic data, National Institute of Health Stroke Scale (NIHSS), and Barthel Index (BI) were collected on all patients on admission, at 7 days, 90 days, 1 year, and 2 years post stroke. Cox proportional hazards models were constructed to identify factors associated with all-cause mortality. A binomial logistic regression model reports odds ratio (OR) for functional independence at 1 year. A total of 986 patients with stroke were included, of which 857 (87%) received neuroimaging. Follow-up rate was 82% at 1 year, missing item data were <1% for most variables. Stroke cases were equally split by sex and mean age was 58.9 (SD: 14.0) years. About 625 (63%) were ischemic, 206 (21%) primary intracerebral hemorrhage, 25 (3%) subarachnoid hemorrhage, and 130 (13%) were of undetermined stroke type. Median NIHSS was 16 (9–24). CFR at 30 days, 90 days, 1 year, and 2 years was 37%, 44%, 49%, and 53%, respectively. Factors associated with increased fatality at any timepoint were male sex (hazard ratio (HR): 1.28 (1.05–1.56)), previous stroke (HR: 1.34 (1.04–1.71)), atrial fibrillation (HR: 1.58(1.06–2.34)), subarachnoid hemorrhage (HR: 2.31 (1.40–3.81)), undetermined stroke type (HR: 3.18 (2.44–4.14)), and in-hospital complications (HR: 1.65 (1.36–1.98)). About 93% of patients were completely independent prior to their stroke, declining to 19% at 1 year after stroke. Functional improvement was most likely to occur between 7 and 90 days post stroke with 35% patients improving, and 13% improving between 90 days to 1 year. Increasing age (OR: 0.97 (0.95–0.99)), previous stroke (OR: 0.50 (0.26–0.98)), NIHSS (OR: 0.89 (0.86–0.91)), undetermined stroke type (OR: 0.18 (0.05–0.62)), and ⩾1 in-hospital complication (OR: 0.52 (0.34–0.80)) were associated with lower OR of functional independence at 1 year. Hypertension (OR: 1.98 (1.14–3.44)) and being the primary breadwinner of the household (OR: 1.59 (1.01–2.49)) were associated with functional independence at 1 year. Stroke affected younger people and resulted in high rates of fatality and functional impairment relative to global averages. Key clinical priorities for reducing fatality include preventing stroke-related complications through evidence-based stroke care, improved detection and management of atrial fibrillation, and increasing coverage of secondary prevention. Further research into care pathways and interventions to encourage care seeking for less severe strokes should be prioritized, including reducing the cost barrier for stroke investigations and care.
登录
查看更多内容
影响因子：
1.9
作者：
Kaduka L;Muniu E;Oduor C;Mbui J;Gakunga R;Kwasa J;Wabwire S;Okerosi N;Korir A;Remick S
通讯作者：
Remick S
DOI：
10.1038/s41582-021-00542-4
发表时间：
2021-10
期刊：
Nature reviews. Neurology
影响因子：
--
作者：
Akinyemi RO;Ovbiagele B;Adeniji OA;Sarfo FS;Abd-Allah F;Adoukonou T;Ogah OS;Naidoo P;Damasceno A;Walker RW;Ogunniyi A;Kalaria RN;Owolabi MO
通讯作者：
Owolabi MO
影响因子：
6.1
作者：
Bonny, Aime;Ngantcha, Marcus;Sliwa, Karen
通讯作者：
Sliwa, Karen
影响因子：
1.8
作者：
Dokponou YCH;Kotecha J;Bandyopadhyay S;Erhabor J;Ooi SZY;Egiz A;Boutarbouch M;Dalle DU;Higginbotham G;Thioub M;Sichimba D;Bankole NDA;Kanmounye US
通讯作者：
Kanmounye US
DOI：
10.1016/j.pmr.2015.07.002
发表时间：
2015-11-01
影响因子：
1.7
作者：
Harvey, Richard L.
通讯作者：
Harvey, Richard L.