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Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study

BACKGROUND: Herpes zoster (HZ) is caused by reactivation of the latent varicella-zoster virus (VZV). A severe complication of HZ is VZV vasculopathy which can result in ischemic or hemorrhagic stroke. The aims of our study were to assess the risk of stroke after the onset of HZ and to investigate th...

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Autores principales: Schink, Tania, Behr, Sigrid, Thöne, Kathrin, Bricout, Hélène, Garbe, Edeltraut
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120818/
https://www.ncbi.nlm.nih.gov/pubmed/27880853
http://dx.doi.org/10.1371/journal.pone.0166554
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author Schink, Tania
Behr, Sigrid
Thöne, Kathrin
Bricout, Hélène
Garbe, Edeltraut
author_facet Schink, Tania
Behr, Sigrid
Thöne, Kathrin
Bricout, Hélène
Garbe, Edeltraut
author_sort Schink, Tania
collection PubMed
description BACKGROUND: Herpes zoster (HZ) is caused by reactivation of the latent varicella-zoster virus (VZV). A severe complication of HZ is VZV vasculopathy which can result in ischemic or hemorrhagic stroke. The aims of our study were to assess the risk of stroke after the onset of HZ and to investigate the roles of stroke subtype, HZ location and the time interval between HZ onset and stroke. METHODS: A self-controlled case-series study was performed on a cohort of patients with incident stroke recorded in the German Pharmacoepidemiological Research Database (GePaRD), which covers about 20 million persons throughout Germany. We estimated adjusted incidence rate ratios (IRR) by comparing the rate of stroke in risk periods (i.e., periods following HZ) with the rate of stroke in control periods (i.e., periods without HZ) in the same individuals, controlling for both time-invariant and major potentially time-variant confounders. RESULTS: The cohort included 124,462 stroke patients, of whom 6,035 (5%) had at least one HZ diagnosis identified in GePaRD either as main hospital discharge diagnosis or as HZ treated with antivirals. The risk of stroke was about 1.3 times higher in the risk periods 3 months after HZ onset, than in the control periods (IRR: 1.29; 95% confidence interval: 1.16–1.44). An elevated risk of similar magnitude was observed for ischemic and unspecified stroke, but a 1.5-fold higher risk was observed for hemorrhagic stroke. A slightly stronger effect on the risk of stroke was also observed during the 3 months after HZ ophthalmicus (HZO) onset (1.59; 1.10–2.32). The risk was highest 3 and 4 weeks after HZ onset and decreased thereafter. CONCLUSIONS: Our study corroborates an increased risk of stroke after HZ, which is highest 3 to 4 weeks after HZ onset. The results suggest that the risk is more pronounced after HZO and is numerically higher for hemorrhagic than for ischemic stroke.
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spelling pubmed-51208182016-12-15 Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study Schink, Tania Behr, Sigrid Thöne, Kathrin Bricout, Hélène Garbe, Edeltraut PLoS One Research Article BACKGROUND: Herpes zoster (HZ) is caused by reactivation of the latent varicella-zoster virus (VZV). A severe complication of HZ is VZV vasculopathy which can result in ischemic or hemorrhagic stroke. The aims of our study were to assess the risk of stroke after the onset of HZ and to investigate the roles of stroke subtype, HZ location and the time interval between HZ onset and stroke. METHODS: A self-controlled case-series study was performed on a cohort of patients with incident stroke recorded in the German Pharmacoepidemiological Research Database (GePaRD), which covers about 20 million persons throughout Germany. We estimated adjusted incidence rate ratios (IRR) by comparing the rate of stroke in risk periods (i.e., periods following HZ) with the rate of stroke in control periods (i.e., periods without HZ) in the same individuals, controlling for both time-invariant and major potentially time-variant confounders. RESULTS: The cohort included 124,462 stroke patients, of whom 6,035 (5%) had at least one HZ diagnosis identified in GePaRD either as main hospital discharge diagnosis or as HZ treated with antivirals. The risk of stroke was about 1.3 times higher in the risk periods 3 months after HZ onset, than in the control periods (IRR: 1.29; 95% confidence interval: 1.16–1.44). An elevated risk of similar magnitude was observed for ischemic and unspecified stroke, but a 1.5-fold higher risk was observed for hemorrhagic stroke. A slightly stronger effect on the risk of stroke was also observed during the 3 months after HZ ophthalmicus (HZO) onset (1.59; 1.10–2.32). The risk was highest 3 and 4 weeks after HZ onset and decreased thereafter. CONCLUSIONS: Our study corroborates an increased risk of stroke after HZ, which is highest 3 to 4 weeks after HZ onset. The results suggest that the risk is more pronounced after HZO and is numerically higher for hemorrhagic than for ischemic stroke. Public Library of Science 2016-11-23 /pmc/articles/PMC5120818/ /pubmed/27880853 http://dx.doi.org/10.1371/journal.pone.0166554 Text en © 2016 Schink et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Schink, Tania
Behr, Sigrid
Thöne, Kathrin
Bricout, Hélène
Garbe, Edeltraut
Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study
title Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study
title_full Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study
title_fullStr Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study
title_full_unstemmed Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study
title_short Risk of Stroke after Herpes Zoster – Evidence from a German Self-Controlled Case-Series Study
title_sort risk of stroke after herpes zoster – evidence from a german self-controlled case-series study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120818/
https://www.ncbi.nlm.nih.gov/pubmed/27880853
http://dx.doi.org/10.1371/journal.pone.0166554
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