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Effect of COPD on the Hospital Outcomes and Mortality among Hemorrhagic Stroke Patients. Sex Differences in a
Javier de Miguel-Diez1, Marta Lopez-Herranz2, Rodrigo Jiménez-García3
1Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain.
Insights
Men with chronic obstructive pulmonary disease (COPD) face a higher risk of hemorrhagic stroke (HS) and in-hospital mortality. Decompressive craniectomy may improve survival rates in these patients.
Area of Science:
- Neurology
- Pulmonology
- Epidemiology
Background:
- The association between chronic obstructive pulmonary disease (COPD) and hemorrhagic stroke (HS) remains unclear.
- Understanding sex differences in HS incidence and outcomes among COPD patients is crucial.
Purpose of the Study:
- To analyze HS incidence, clinical features, procedures, and outcomes in patients with and without COPD.
- To investigate sex-specific differences in HS among COPD patients.
- To identify factors associated with in-hospital mortality (IHM) in HS patients with COPD.
Main Methods:
- Analysis of patients aged ≥40 years hospitalized with HS from the Spanish National Hospital Discharge Database (2016-2018).
- Utilized propensity score matching (PSM) to compare outcomes based on sex and COPD status.
- Investigated factors influencing in-hospital mortality.
Main Results:
- COPD men exhibited a higher adjusted incidence of HS compared to non-COPD men (IRR 1.31) and COPD women (IRR 1.87).
- After matching, COPD men had significantly higher in-hospital mortality (29.96%) than non-COPD men (27.46%).
- Decompressive craniectomy was performed more often in COPD men than COPD women and was linked to reduced IHM.
Conclusions:
- COPD is associated with increased HS incidence and in-hospital mortality, particularly in men.
- Sex disparities exist in HS incidence, with COPD men being more affected than COPD women.
- Decompressive craniectomy may be a beneficial intervention for improving survival in COPD patients experiencing HS.
Abstract:
(1) Background: It is not well known whether there is an association between COPD and hemorrhagic stroke (HS). We aim to analyze the incidence, clinical characteristics, procedures, and outcomes of HS in patients with and without COPD and to assess sex differences. Secondly, to identify factors associated with in-hospital mortality (IHM). (2) Methods: Patients aged ≥40 years hospitalized with HS included in the Spanish National Hospital Discharge Database (2016-2018) were analyzed. Propensity score matching (PSM) was used to compare patients according to sex and COPD status. (3) Results: We included 55,615 patients (44.29% women). Among men with COPD the HS adjusted incidence was higher (IRR 1.31; 95% CI 1.24-1.57) than among non-COPD men. COPD men had higher adjusted incidence of HS than COPD women (IRR 1.87; 95% CI 1.85-1.89). After matching, COPD men had a higher IHM (29.96% vs. 27.46%; p = 0.032) than non-COPD men. Decompressive craniectomy was more frequently conducted among COPD men than COPD women (6.74% vs. 4.54%; p = 0.014). IHM increased with age and atrial fibrillation, while decompressive craniectomy reduced IHM. (4) Conclusions: COPD men had higher incidence and IHM of HS than men without COPD. COPD men had higher incidence of HS than COPD women. Decompressive craniectomy was more frequently conducted in COPD men than COPD women and this procedure was associated to better survival.
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