Abstract
BackgroundThe risk and outcomes of stroke in patients with chronic obstructive pulmonary disease exacerbations (COPDe) remain unclear. We examined whether patients with COPDe faced increased risk of stroke or post-stroke outcomes.MethodsUsing Taiwan’s National Health Insurance Research Database, we identified 1918 adults with COPDe and selected comparison cohorts of 3836 adults with COPD no exacerbations and 7672 adults without COPD who were frequency matched by age and sex in 2000–2008 (Study 1). Stroke event was identified during 2000–2013 follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke associated with COPDe were calculated. In a nested cohort study (Study 2) of 261686 new-diagnosed stroke patients in 2000–2009, we calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after stroke in patients with COPDe.ResultsPatients with COPDe had increased stroke incidence, with an adjusted HR of 1.28 (95% CI, 1.03–1.59). In the Study 2, COPDe were associated with post-stroke mortality (OR, 1.34, 95% CI 1.20–1.52), epilepsy (OR, 1.43; 95% CI, (1.22–1.67), and pneumonia (OR, 1.50; 95% CI, 1.39–1.62). Previous intubation for COPD and inpatient admissions due to COPD were factors associated with post-stroke adverse events.ConclusionPatients who have had COPDe face increased risks of stroke and post-stroke adverse events.
Highlights
Chronic obstructive pulmonary disease (COPD) was the fourth leading cause of death worldwide in 2008, and it is expected to move to third place by 2020 [1,2,3]
Patients with chronic obstructive pulmonary disease exacerbations (COPDe) had increased stroke incidence, with an adjusted hazard ratio (HR) of 1.28
In the Study 2, COPDe were associated with post-stroke mortality (OR, 1.34, 95% confidence interval (CI) 1.20–1.52), epilepsy (OR, 1.43; 95% CI, (1.22–1.67), and pneumonia (OR, 1.50; 95% CI, 1.39–1.62)
Summary
Chronic obstructive pulmonary disease (COPD) was the fourth leading cause of death worldwide in 2008, and it is expected to move to third place by 2020 [1,2,3]. Stroke was the second leading cause of death worldwide in 2010. It causes serious longterm disability and associated costs; in 2010 U.S economic losses from stroke cost an estimated $73.7 billion [7]. Other risk factors associated with stroke require further study. The risk and outcomes of stroke in patients with chronic obstructive pulmonary disease exacerbations (COPDe) remain unclear. We examined whether patients with COPDe faced increased risk of stroke or post-stroke outcomes
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