Post-Stroke Outcomes of Patients with Chronic Obstructive Pulmonary Disease

Szylińska, Aleksandra; Kotfis, Katarzyna; Bott-Olejnik, Marta; Wańkowicz, Paweł; Rotter, Iwona

doi:10.3390/brainsci12010106

Cited by 10 publications

(14 citation statements)

References 36 publications

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“…Firstly, the airway structure of COPD patients is significantly different from the normal population, and the incidence of post-stroke pneumonia is significantly higher due to airway spasms, destruction and collapse of the airway wall, poor cilia function, and sputum aggregation. [9,45] Secondly, some studies have also reported that COPD patients' mortality may be associated with post-stroke complications such as urinary tract infection, acute heart attack, and congestive heart failure. [26,36] Therefore, these comorbidities in COPD patients may increase the risk of post-stroke death.…”

Section: Variablesmentioning

confidence: 99%

“…Some studies have shown that patients with COPD have an increased risk of death after stroke. [8,9] However, other studies possess a different view. [10] Therefore, we systematically evaluated the literature on the risk of stroke in COPD patients, the correlation between AECOPD and stroke risk, short-term mortality risk after stroke in COPD patients, and long-term mortality risk after stroke in COPD patients; to comprehensively explore the relationship between COPD and stroke.…”

Section: Introductionmentioning

confidence: 99%

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Stroke risk of COPD patients and death risk of COPD patients following a stroke: A systematic review and meta-analysis

Ding,

Wang,

Gong

et al. 2023

Medicine

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Objective: Chronic obstructive pulmonary disease (COPD) is closely related to the development and progression of cardiovascular disease. The purpose of this study is to clarify the answers to the following questions through systematic evaluation: the risk of stroke in COPD patients; the risk of stroke in acute exacerbations of COPD (AECOPD) patients; and the risk of death after stroke in COPD patients. Methods: Two reviewers independently searched EMbase, PubMed, and the Cochrane Library for relevant literature from the date of creation to February 17, 2023, for studies relating COPD to stroke patients. Of the 8039 publications retrieved, we identified 27 articles that met our selection criteria. Fixed-effects or random-effects models were used to calculate ORs and 95% confidence intervals for the combined risk. Results: combining studies on stroke risk in COPD patients by random-effects model suggested that COPD was an independent risk factor for stroke-associated pneumonia (OR 1.40, 95% CI: 1.24–1.59, I 2 = 98.4%, P = .000), with significant heterogeneity in the results, and subgroup analysis did not find a source of heterogeneity. In the combined 7 AECOPD studies, a significantly higher risk of stroke was found (OR 1.53, 95% CI: 1.44–1.63, I 2 = 49.2%, P = .066). In the combined 6 short- term prognostic studies, the relationship between COPD and risk of death was not highly significant (OR 1.12, 95% CI: 1.08–1.16, I 2 = 37.4%, P = .131). In 10 long-term observational prognosis studies, COPD was suggested to be associated with death after stroke by combining data using a random-effects model (OR 1.20, 95% CI: 1.13–1.27, I 2 = 56.8%, P = .014), and there was moderate heterogeneity in the combination, with subgroup analysis showing that stroke type may be a source of heterogeneity and the risk of death from ischemic stroke: OR 1.23, 95% CI: 1.17–1.29, I 2 = 45.0%, P = .191 and the risk of death from both types of stroke: OR 1.12, 95% CI: 1.07–1.18, I 2 =18.9%, P = .291. Conclusion: COPD is an independent risk factor for stroke. The risk of stroke is significantly increased, especially during AECOPD. In addition, the association between COPD and short-term death in stroke patients is insignificant, while it is more associated with fatal events in the long-term prognosis.

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Section: Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stroke risk of COPD patients and death risk of COPD patients following a stroke: A systematic review and meta-analysis

Ding,

Wang,

Gong

et al. 2023

Medicine

View full text Add to dashboard Cite

show abstract

“…Previous studies on the predictors of infection in stroke patients revealed that nasogastric tube use, atrial fibrillation, total anterior circulation syndrome, and urinary catheter usage increased the risk of post-stroke infection [ 10 ]. Another meta-analysis on risk factors for post-stroke pneumonia showed that advanced age, male sex, stroke severity, dysphagia, nasogastric tube use, diabetes, mechanical ventilation, smoking, chronic obstructive pulmonary disease, and atrial fibrillation are predictors [ 11 , 12 , 13 ]. However, most studies focused on pneumonia, and research on all-cause post-stroke infections is limited.…”

Section: Introductionmentioning

confidence: 99%

Post-Stroke Infections: Insights from Big Data Using Clinical Data Warehouse (CDW)

Jung

Park

et al. 2023

Antibiotics

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This study analyzed a digitized database of electronic medical records (EMRs) to identify risk factors for post-stroke infections. The sample included 41,236 patients hospitalized with a first stroke diagnosis (ICD-10 codes I60, I61, I63, and I64) between January 2011 and December 2020. Logistic regression analysis was performed to examine the effect of clinical variables on post-stroke infection. Multivariable analysis revealed that post-stroke infection was associated with the male sex (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.49–2.15), brain surgery (OR: 7.89; 95% CI: 6.27–9.92), mechanical ventilation (OR: 18.26; 95% CI: 8.49–44.32), enteral tube feeding (OR: 3.65; 95% CI: 2.98–4.47), and functional activity level (modified Barthel index: OR: 0.98; 95% CI: 0.98–0.98). In addition, exposure to steroids (OR: 2.22; 95% CI: 1.60–3.06) and acid-suppressant drugs (OR: 1.44; 95% CI: 1.15–1.81) increased the risk of infection. On the basis of the findings from this multicenter study, it is crucial to carefully evaluate the balance between the potential benefits of acid-suppressant drugs or corticosteroids and the increased risk of infection in patients at high risk for post-stroke infection.

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“…Additionally, patients with COPD were reportedly at a higher risk of developing stroke, [1] and patients with stroke and underlying COPD were at a higher risk of in-hospital complications and mortality than those without COPD. [2][3][4] The mainstream therapy for stable-state COPD is a combination of inhalers depending on the severity of the disease. [5] Inhalers have been demonstrated to improve COPD outcomes, including improving respiratory symptoms and quality of life, reducing the frequency of acute exacerbations, and reducing mortality.…”

Section: Introductionmentioning

confidence: 99%

Association between use of transdermal tulobuterol and short-term outcomes in patients with stroke and underlying chronic obstructive pulmonary disease: A retrospective cohort study

Matsuo,

Jo,

Makito

et al. 2023

Medicine

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Transdermal tulobuterol, a long-acting beta agonist in a transdermal form, is available in some countries, including Japan, Korea, and China. It may provide an alternative treatment option for the management of chronic obstructive pulmonary disease (COPD) in patients who are unable to effectively use inhalers, such as those with acute stroke. This study examined the short-term outcomes of transdermal tulobuterol in patients hospitalized with acute stroke and underlying COPD. Using the Diagnosis Procedure Combination database, a national inpatient database in Japan, we identified patients with stroke and underlying COPD who were hospitalized between July 2010 and March 2021. We performed propensity-score overlap weighting to compare in-hospital death, COPD exacerbation, pneumonia, and cardiac complications between patients who initiated transdermal tulobuterol within 2 days of admission and those who did not use it during hospitalization. Of the 1878 eligible patients, 189 received transdermal tulobuterol within 2 days of admission. After adjusting for baseline variables, transdermal tulobuterol was not associated with a reduction in in-hospital death (18.3% vs 16.1%; odds ratio, 1.17; 95% confidence interval, 0.72–1.90). Additionally, we observed no significant difference in COPD exacerbation, pneumonia, and cardiac complications between both groups. Transdermal tulobuterol was not associated with improving short-term outcomes in patients with acute stroke and underlying COPD. Our study does not support the routine use of transdermal tulobuterol in this patient group. However, further research investigating the long-term efficacy of transdermal tulobuterol in patients with stroke and underlying COPD could help establish its role for the management of these patients.

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Post-Stroke Outcomes of Patients with Chronic Obstructive Pulmonary Disease

Cited by 10 publications

References 36 publications

Stroke risk of COPD patients and death risk of COPD patients following a stroke: A systematic review and meta-analysis

Stroke risk of COPD patients and death risk of COPD patients following a stroke: A systematic review and meta-analysis

Post-Stroke Infections: Insights from Big Data Using Clinical Data Warehouse (CDW)

Association between use of transdermal tulobuterol and short-term outcomes in patients with stroke and underlying chronic obstructive pulmonary disease: A retrospective cohort study

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