Lekoubou Alain, Ovbiagele Bruce
Medical University of South Carolina, Charleston, SC.
eNeurologicalSci. 2017 Mar;6:21-24. doi: 10.1016/j.ensci.2016.11.007. Epub 2016 Nov 5.
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.
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.
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).
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.
慢性阻塞性肺疾病（COPD）和中风是重要的死亡原因。COPD患者发生脑缺氧和误吸的风险更高。然而，关于中风患者中COPD的患病率及其对首次中风后预后的影响，人们了解得相对较少。我们在一个具有全国代表性的样本中评估住院中风患者中COPD的患病率，并研究COPD对中风后医院死亡率风险的影响。
利用国家住院患者样本，这是一个2004年1月至2009年12月期间美国医院入院情况的全国代表性数据集（n = 48,087,002），我们评估了中风患者中COPD的粗患病率和年龄调整患病率，以及按COPD状态划分的住院死亡率。使用多变量逻辑回归评估COPD与中风后住院死亡率的独立关联。
所有因中风住院的成年患者中，11.71%（95%可信区间：11.48 - 11.94%）患有COPD。这些患者的粗住院死亡率和年龄调整住院死亡率分别为6.33%（95%可信区间：6.14 - 6.53%）和5.99%（95%可信区间：4.05 - 7.94%）。在多变量分析中，COPD与总体中风死亡率适度相关（比值比1.03；95%可信区间1.01 - 1.06；p = 0.018）。脑出血患者（比值比：1.12；95%可信区间1.03 - 1.20；p = 0.005）和缺血性中风患者（比值比1.08；95%可信区间1.03 - 1.13，p = 0.001）的死亡风险更高。
12%的住院中风患者患有COPD。COPD的存在与中风期间更高的死亡几率独立相关。需要进行前瞻性研究以确定导致这种有害关系的任何可改变的风险因素。
