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

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.