Prevalence and influence of chronic obstructive pulmonary disease on stroke outcomes in hospitalized stroke patients

Abstract

BACKGROUND Chronic obstructive pulmonary disease (COPD) and stroke are important causes of death. COPD patients are at higher risk of cerebral hypoxia and aspiration. Yet, relatively little is known about the prevalence of COPD among stroke patients or its impact on outcomes after an index stroke. We assess the prevalence of COPD among hospitalized stroke patients in a nationally representative sample and examine the effect of COPD with mortality risk in the hospital after a stroke. METHODS Using the National Inpatient Sample, a nationally representative dataset of US hospital admissions between January 2004 and December 2009 (n=48,087,002), we assessed Crude and age-adjusted COPD prevalence among stroke patients and in-hospital mortality rates by COPD status. Independent associations of COPD with in-hospital mortality following stroke were evaluated using multivariable logistic regression. RESULTS 11.71% (95% CI: 11.48–11.94%) of all adult patients hospitalized for stroke had COPD. The crude and age-adjusted in-hospital mortality rates for these patients were 6.33% (95% CI: 6.14–6.53%) and 5.99% (95% CI: 4.05–7.94%), respectively. On multivariable analyses, COPD was modestly associated with overall stroke mortality (OR 1.03; 95% CI 1.01–1.06; p=0.018). The greater risks of mortality were seen among those with intracerebral hemorrhage (OR: 1.12; 95% CI 1.03–1.20; p=0.005) and ischemic stroke patients (OR 1.08; 95% CI 1.03–1.13, p=0.001). CONCLUSIONS 12% of hospitalized stroke patients have COPD. The presence of COPD is independently associated with higher odds of dying during stroke. Prospective studies are needed to identify any modifiable risk factors contributing to this deleterious relationship.

<p>Insights into Chronic Obstructive Pulmonary Disease as Critical Risk Factor for Cardiovascular Disease</p>

“…This study shows that the presence of COPD is an independent risk factor for early mortality in stroke patients. 85…”

Impact of Chronic Obstructive Pulmonary Disease on In-hospital Mortality in Patients with Aneurysmal Subarachnoid Hemorrhage: An Observational Cohort Study with Propensity Score Matching

“…[7] Only one observational study has addressed the association between COPD and mortality in patients with SAH. [8] That study demonstrated that COPD did not increased mortality. However, that study did not control for important confounders, such as severity of disease, smoking, or medical history.…”

“…With the increasing global incidence of COPD [13] and its high prevalence in patient with aSAH [8], we assessed the impact of COPD on outcomes of in patients with aSAH, using propensity score matching (PSM) to form groups for comparison with near-identical distributions of background and potential confounder variables.…”

Chronic Obstructive Pulmonary Disease and Stroke

“…On multivariable analyses, COPD is modestly associated with overall stroke mortality (OR 1.06; 95% CI 1.02-1.08; p=0.018) but it is strongly associated with higher mortality among patients with intracerebral hemorrhage (OR 1.12; 95% CI 1.03-1.20; p=0.005) and ischemic stroke (OR 1.08; 95% CI 1.03-1.13, p=0.001). However, no excess mortality was 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 observed among COPD patients when the analysis was restricted to ischemic stroke patients who received recombinant tissue plasminogen factor (10).…”

“…It has been demonstrated that there is a tight interplay between COPD, acute and chronic cardiovascular disease. (7)(8)(9) But it has also been suggested that COPD is significantly more prevalent among patients with stroke and that the co-existence of both is associated with grim outcomes (10). These findings have been consistently observed in studies evaluating all different subtypes of stroke (ischaemic, intracerebral or subarachnoid hemorrhage) (11).…”