title: Risk of Stroke and Post-Stroke Adverse Events in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease.
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.
  
  
  CONCLUSIONS
  Patients who have had COPDe face increased risks of stroke and post-stroke adverse events.
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.|Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.|Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chao-Shun
authors.initials: CS
authors.lastname: Lin
authors.affiliation: School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chun-Chuan
authors.initials: CC
authors.lastname: Shih
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, Taiwan.|Department of Surgery, University of Illinois, Chicago, Illinois, United States of America.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.affiliation: Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
authors.forename: Chaur-Jong
authors.initials: CJ
authors.lastname: Hu
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Chi-Li
authors.initials: CL
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.|Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.|Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ta-Liang
authors.initials: TL
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.|Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.|Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.|Department of Anesthesiology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D013624:Taiwan / Q000453:epidemiology