Risk of Stroke and Post-Stroke Adverse Events in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease

PLoS One. 2017 Jan 6;12(1):e0169429. doi: 10.1371/journal.pone.0169429. eCollection 2017.

Abstract

Background: 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.

Methods: Using 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.

Results: Patients 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.

Conclusion: Patients who have had COPDe face increased risks of stroke and post-stroke adverse events.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Disease Progression
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Outcome Assessment
  • Population Surveillance
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stroke / epidemiology*
  • Stroke / etiology*
  • Stroke / mortality
  • Taiwan / epidemiology

Grants and funding

This research was supported in part by Shuang Ho Hospital, Taipei Medical University (104TMU-SHH-23), Taiwan’s Ministry of Science and Technology (MOST105-2629-B-038-001; MOST105-2314-B-038-025; MOST105-2221-E-038-014; MOST104-2314-B-038-027-MY2; MOST104-2221-E-038-015; NSC102-2314-B-038-021-MY3), and Taiwan’s Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.