Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study.
Patient-level and system-level determinants of stroke fatality across 16 large hospitals in Ghana and Nigeria: a prospective cohort study.
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DOI：
10.1016/s2214-109x(23)00038-4
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发表时间：
2023-04
影响因子：
34.3
通讯作者：
Owolabi, Mayowa O.
中科院分区：
文献类型：
--
作者：
Sarfo, Fred S.;Akpa, Onoja M.;Ovbiagele, Bruce;Akpalu, Albert;Wahab, Kolawole;Obiako, Reginald;Komolafe, Morenikeji;Owolabi, Lukman;Ogbole, Godwin;Fakunle, Adekunle;Okekunle, Akinkunmi Paul;Asowata, Osahon J.;Calys-Tagoe, Benedict;Uvere, Ezinne O.;Sanni, Taofeek;Olowookere, Samuel;Ibinaiye, Philip;Akinyemi, Joshua O.;Arulogun, Oyedunni;Jenkins, Carolyn;Lackland, Daniel T.;Tiwari, Hemant K.;Isah, Suleiman Y.;Abubakar, Sani A.;Oladimeji, Adebayo;Adebayo, Philip;Akpalu, Josephine;Onyeonoro, Ugochukwu;Ogunmodede, James A.;Akisanya, Cynthia;Mensah, Yaw;Oyinloye, Olalekan, I;Appiah, Lambert;Agunloye, Atinuke M.;Osaigbovo, Godwin;Adeoye, Abiodun M.;Adeleye, Osimhiarherhuo Ohifemen;Laryea, Ruth Y.;Olunuga, Taiwo;Ogah, Okechukwu S.;Oguike, Wisdom;Ogunronbi, Mayowa;Adeniyi, Wasiu;Olugbo, Obiabo Y.;Bello, Abiodun H.;Ogunjimi, Luqman;Diala, Samuel;Dambatta, Hamisu A.;Singh, Arti;Adamu, Sheila;Obese, Vida;Adusei, Nathaniel;Owusu, Dorcas;Ampofo, Michael;Tagge, Raelle;Fawale, Bimbo;Yaria, Joseph;Akinyemi, Rufus O.;Owolabi, Mayowa O.
每分钟就有6个非洲土著发展出新的笔法。患者层面和系统层面对该地区早期卒中死亡的影响尚不清楚。我们的目的是确定和量化加纳和尼日利亚16家医院住院中风病死率的患者层面和系统层面决定因素的贡献。中风调查研究和教育网络（SIREN）是一项涉及加纳和尼日利亚16个站点的多中心研究。病例包括有急性脑卒中临床和放射学证据的成人（年龄≥18岁）。收集每个研究地点卒中服务和可用资源的数据并作为系统级因素进行分析。将病例的大量人口统计学和临床变量作为患者水平的因素进行分析。拟合了包括患者水平和系统水平协变量的混合效应对数二项模型。结果以校正风险比（arr）表示，其ci分别为95%。总体而言，3739例卒中患者中有814例（21.8%）在住院期间死亡：2635例缺血性卒中患者中有476例（18.1%），1104例脑出血患者中有338例（30.6%）。使用模型簇内相关系数评估的研究地点的系统级因素可归因于卒中死亡几率的可变性很大，为7.3%（高于5%的阈值）。在16个中心中，只有5个中心设有中风病房。与脑卒中死亡相关的6个患者水平因素的arr为：蔬菜摄入量低，1.19 (95% CI 1.07 - 1.33)；收缩压每升高10mmhg，为1.02 (1.01 ~ 1.04)；脑卒中病变体积大于30 cm3，为1.48(1.22 - 1·79)；美国国立卫生研究院卒中量表（NIHSS）评分每上升5个单位为1.20 (1.13 - 1.26)；颅内压升高，1.75 (1.31 ~ 1.33)；吸入性肺炎1.79例（1.16 ~ 2.77例）。需要研究来评估针对患者水平因素（如吸入性肺炎）的干预措施在降低该地区急性卒中死亡率方面的有效性。改善中风治疗的政策指令是必要的。美国国立卫生研究院。
Every minute, six indigenous Africans develop new strokes. Patient-level and system-level contributors to early stroke fatality in this region are yet to be delineated. We aimed to identify and quantify the contributions of patient-level and system-level determinants of inpatient stroke fatality across 16 hospitals in Ghana and Nigeria. The Stroke Investigative Research and Educational Network (SIREN) is a multicentre study involving 16 sites in Ghana and Nigeria. Cases include adults (aged ≥18 years) with clinical and radiological evidence of an acute stroke. Data on stroke services and resources available at each study site were collected and analysed as system-level factors. A host of demographic and clinical variables of cases were analysed as patient-level factors. A mixed effect log-binomial model including both patient-level and system-level covariates was fitted. Results are presented as adjusted risk ratios (aRRs) with respective 95% CIs. Overall, 814 (21·8%) of the 3739 patients admitted with stroke died as inpatients: 476 (18·1%) of 2635 with ischaemic stroke and 338 (30·6%) of 1104 with intracerebral haemorrhage. The variability in the odds of stroke fatality that could be attributed to the system-level factors across study sites assessed using model intracluster correlation coefficient was substantial at 7·3% (above a 5% threshold). Stroke units were available at only five of 16 centres. The aRRs of six patient-level factors associated with stroke fatality were: low vegetable consumption, 1·19 (95% CI 1·07–1·33); systolic blood pressure, 1·02 (1·01–1·04) for each 10 mm Hg rise; stroke lesion volume more than 30 cm3, 1·48 (1·22–1·79); National Institutes of Health Stroke Scale (NIHSS) score, 1·20 (1·13–1·26) for each 5-unit rise; elevated intracranial pressure, 1·75 (1·31–2·33); and aspiration pneumonia, 1·79 (1·16–2·77). Studies are needed to assess the efficacy of interventions targeting patient-level factors such as aspiration pneumonia in reducing acute stroke fatality in this region. Policy directives to improve stroke unit access are warranted. US National Institutes of Health.