Parkinson’s Disease and Patient Related Outcomes in Stroke: A matched cohort study

Jesus A. Perdomo-Lampignano, Tiberiu A. Pana, Isobel Sleeman, Allan B. Clark, Kittisak Sawanyawisuth, Narongrit Kasemap, Somsak Tiamkao, Phyo K. Myint*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objective
To evaluate post-stroke outcomes in patients with Parkinson's disease (PD).
Methods
A matched cohort study was performed. Stroke patients with PD and non-PD controls were extracted from the Thailand Universal Insurance Database. Logistic regressions were used to evaluate the association between PD and in-hospital outcomes (mortality and complications). The PD-associated long-term mortality was evaluated using Royston-Parmar models.
Results
A total of 1967 patients with PD were identified between 2003 and 2015 and matched to controls (1:4) by age, sex, admission year, and stroke type. PD patients had decreased odds of in-hospital death: OR (95% CI) 0.66 (0.52 – 0.84) and 0.61 (0.43 – 0.85) after ischaemic and haemorrhagic strokes, respectively. PD was associated with a length-of-stay greater than median (4 days) after both stroke types: 1.37 (1.21 – 1.56) and 1.45 (1.05 – 2.00), respectively. Ischaemic stroke patients with PD also had increased odds of developing pneumonia, sepsis and AKI: 1.52 (1.2 – 1.83), 1.54 (1.16 – 2.05), and 1.33 (1.02 – 1.73). In haemorrhagic stroke patients, PD was associated with pneumonia: 1.89 (1.31 – 2.72). Survival analyses showed that PD was protective against death in the short term (HR=0.66; 95% CI 0.53–0.83 ischaemic, and HR=0.50; 95% CI 0.37 – 0.68 haemorrhagic stroke), but leads to an increased mortality risk approximately 1 and 3 months after ischaemic and haemorrhagic stroke, respectively.
Conclusion
PD is associated with a reduced mortality risk during the first 2–4 weeks post-admission but an increased risk thereafter, in addition to increased odds of in-hospital complications and prolonged hospitalisation.
Original languageEnglish
Article number104826
Number of pages8
JournalJournal of Stroke and Cerebrovascular Diseases
Early online date10 May 2020
DOIs
Publication statusE-pub ahead of print - 10 May 2020

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Keywords

  • Ischaemic stroke
  • Haemorrhagic stroke
  • Parkinson's disease
  • Matched cohort study

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