Abstract

Association Between Chronic Inflammatory Diseases and Stroke-Associated Pneumonia - An Epidemiological Study

J Stroke Cerebrovasc Dis. 2021 Jan 19;30(4):105605.doi: 10.1016/j.jstrokecerebrovasdis.2021.105605. Online ahead of print.

Layne Dylla 1, Paco S Herson 2, Sharon N Poisson 3, John D Rice 4, Adit A Ginde 5

 
     

Author information

  • 1Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave., B215, Aurora, CO 80045, United States. Electronic address: Layne.Dylla@cuanschutz.edu.
  • 2Department of Anesthesiology, University of Colorado School of Medicine, United States.
  • 3Department of Neurology, University of Colorado School of Medicine, United States.
  • 4Department of Biostatistics and Informatics, Colorado School of Public Health, United States.
  • 5Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave., B215, Aurora, CO 80045, United States.

Abstract

Background: Pneumonia, the most common post-acute ischemic stroke (AIS) infection, accounts for up to 30% of deaths after a stroke. Multiple chronic inflammatory diseases, such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease, are associated with increased risk of stroke and stroke morbidity. This study assessed the relationship between chronic inflammatory diseases and stroke-associated pneumonia (SAP).

Methods: Using data from the 2015-2017 National Inpatient Sample, we classified hospital discharges with a diagnosis of AIS as having ulcerative colitis, Crohn's disease, rheumatoid arthritis, psoriasis, systemic lupus erythematosus, other chronic inflammatory diseases, multiple chronic inflammatory diseases, or none. With multivariable logistic regression, we assessed for associations between chronic inflammatory disease and in-hospital SAP or death.

Results: Among AIS discharges, there was a decreased risk of SAP among those with psoriasis or other chronic inflammatory diseases (adjusted odds ratio (aOR) 0.70, 95%CI 0.63-0.99; aOR 0.64, 95%CI, 0.46-0.89, respectively), compared to those without psoriasis and without other chronic inflammatory disease, respectively. Rheumatoid arthritis, psoriasis, and other chronic inflammatory diseases were associated with reduced in-hospital mortality (aOR 0.89, 95%CI 0.78-1.00; aOR 0.77, 95%CI 0.59-1.00; aOR 0.69, 95%CI 0.50-0.94, respectively).

Conclusions: The risk of SAP and in-hospital mortality varies by chronic inflammatory disease - psoriasis and other chronic inflammatory diseases are associate with reduced rates of SAP, whereas rheumatoid arthritis, psoriasis and other chronic inflammatory disease were associated with reduced in-hospital mortality. Further investigations are needed to determine a relationship between the potential role of immunomodulation and the reduction in SAP and mortality in chronic inflammatory diseases.

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