Development of a Clinical Score (A
            <sup>2</sup>
            DS
            <sup>2</sup>
            ) to Predict Pneumonia in Acute Ischemic Stroke

Höffmann, Sarah; Malzahn, Uwe; Harms, Hendrik; Koennecke, Hans–Christian; Berger, Klaus; Kalic, Marianne; Walter, G.; Meisel, Andreas; Heuschmann, Peter U.

doi:10.1161/strokeaha.112.653055

Cited by 190 publications

(197 citation statements)

References 40 publications

(29 reference statements)

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“…Findings of the study showed that smoking, alcohol intake, dysphagia, age, hemorrhagic type of stroke, and need for intubation were factors independently increased the risk for developing pneumonia. Age, dysphagia, hemorrhagic stroke, and need for intubation have all been previously reported as risk factors for stroke-associated pneumonia, [1,4,5,[9][10][11][12][13] which is consistent with our findings. However, this study identified another risk factor not yet reported in literature which is alcohol intake, but the data on the amount and duration of alcohol intake were not obtained.…”

Section: Discussionsupporting

confidence: 93%

“…[1,6,9,13] In this study, the mean NIHSS for the cases is 19, while that for the controls is 11 with an overlap in the NIHSS scores between the two groups, suggesting statistically non-significant OR. Clinically, stroke severity can be classified using NIHSS scores as to mild (≤4), moderate (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and severe (more than 15). Based on the mean scores, this study suggests that NIHSS scores differed in both groups clinically but did not attain statistical significance.…”

Section: Discussionmentioning

confidence: 47%

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Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Castillo¹,

Sumalapao²,

Pascual³

2017

Natl J Physiol Pharm Pharmacol

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Background: Knowledge on the risk factors of developing pneumonia, one of the top causes of mortality in acute stroke patients admitted to a tertiary government hospital, is lacking. Aim and Objective: This study aimed to determine the factors associated with the risk of developing pneumonia in acute stroke patients admitted to the emergency department of a tertiary government hospital. Materials and Methods: A retrospective matched case-control study involving acute stroke patients admitted to the emergency department of a tertiary government hospital with 168 pneumonia patients matched with 168 controls by sex was employed. Age, sex, vascular risk factors, previous hospitalization within the past 3 months, type and location of stroke, need for intubation, length of hospital emergency room stay, National Institute of Health Stroke Scale (NIHSS) score on admission, pre-morbid Modified Rankin Scale (mRS) score, and outcome (mortality, NIHSS score and mRS score at discharge) were obtained from the medical charts. Odds ratios were calculated using a multivariate logistic regression analysis. Among stroke patients developing pneumonia, the type of pneumonia and microorganisms were identified. Results: Smoking, alcohol intake, dysphagia, hemorrhagic stroke, need for intubation, and age were associated with pneumonia. Pneumonia increases the odds of mortality and disability by 14 and 7 times, respectively. Hospital-acquired pneumonia is the most common type with Acinetobacter baumanii and Klebsiella pneumonia as the most common microorganisms identified. Conclusion: Age, alcohol intake, dysphagia, hemorrhagic stroke, and need for intubation increase the risk for post-stroke pneumonia with organisms isolated consistent with nosocomial pneumonia.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 47%

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Castillo¹,

Sumalapao²,

Pascual³

2017

Natl J Physiol Pharm Pharmacol

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“…Calibration was assessed by performing the Hosmer-Lemeshow goodness-of-fit test and was graphically depicted in the plot of observed versus predicted SAP risk according to 10 deciles of predicted risk. Furthermore, we compared the discrimination of the AIS-APS and 3 prior scores, [25][26][27] with regard to in-hospital SAP after AIS. The AUROC and maximum Youden index were used to assess the discrimination of these scores for in-hospital SAP after AIS.…”

Section: Discussionmentioning

confidence: 99%

Novel Risk Score to Predict Pneumonia After Acute Ischemic Stroke

Shen²,

Pan

et al. 2013

Stroke

142

157

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Background and Purpose— To develop and validate a risk score (acute ischemic stroke-associated pneumonia score [AIS-APS]) for predicting in-hospital stroke-associated pneumonia (SAP) after AIS. Methods— The AIS-APS was developed based on the China National Stroke Registry, in which eligible patients were randomly classified into derivation (60%) and internal validation cohort (40%). External validation was performed using the prospective Chinese Intracranial Atherosclerosis Study. Independent predictors of in-hospital SAP after AIS were obtained using multivariable logistic regression, and β-coefficients were used to generate point scoring system of the AIS-APS. The area under the receiver operating characteristic curve and the Hosmer–Lemeshow goodness-of-fit test were used to assess model discrimination and calibration, respectively. Results— The overall in-hospital SAP after AIS was 11.4%, 11.3%, and 7.3% in the derivation (n=8820), internal (n=5882) and external (n=3037) validation cohort, respectively. A 34-point AIS-APS was developed from the set of independent predictors including age, history of atrial fibrillation, congestive heart failure, chronic obstructive pulmonary disease and current smoking, prestroke dependence, dysphagia, admission National Institutes of Health Stroke Scale score, Glasgow Coma Scale score, stroke subtype (Oxfordshire), and blood glucose. The AIS-APS showed good discrimination (area under the receiver operating characteristic curve) in the internal (0.785; 95% confidence interval, 0.766–0.803) and external (0.792; 95% confidence interval, 0.761–0.823) validation cohort. The AIS-APS was well calibrated (Hosmer–Lemeshow test) in the internal ( P =0.22) and external ( P =0.30) validation cohort. When compared with 3 prior scores, the AIS-APS showed significantly better discrimination with regard to in-hospital SAP after AIS (all P <0.0001). Conclusions— The AIS-APS is a valid risk score for predicting in-hospital SAP after AIS.

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“…Therefore, there is lacking risk stratification and precise therapeutic regimen of SAP. Sarah et al [2] carried out an assessment and analysis on multiple risk factors of SAP in 15 335 patients with acute ischemic stroke, and established the A2DS2 scoring tool. They found that the tool had excellent resolving power for prediction of SAP, and may be used in identification of patients at high risk and to guide preventive and management measures for pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, early identification of patients at a high risk of SAP may help physicians to monitor the disease and prescribe proper treatment. A2DS2 scoring tool [2] is recognized as an effective method for predicting SAP. In this study, the A2DS2 scoring tool was used to evaluate the risk and prognosis of pneumonia in cerebral stroke patients treated in our department from 2009 to 2011.…”

Section: Introductionmentioning

confidence: 99%

Risk assessment of ischemic stroke associated pneumonia

Li¹,

Zhang²,

Wu-ping³

et al. 2014

World Journal of Emergency Medicine

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BACKGROUND: Cerebral stroke is a disease with a high disability rate and a high fatality rate. This study was undertaken to assess the risk of stroke associated pneumonia (SAP) in patients with ischemic stroke using A2DS2 score. METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows: age ≥75 years=1, atrial fi brillation=1, dysphagia=2, male sex=1; stroke severity: NIHSS score 0-4=0, 5-15=3, ≥16=5. The patients were divided into three groups according to A2DS2 score: 620 in score 0 group, 383 in score 1-9 group, and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows: newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection: (1) fever ≥38 °C; (2) newly occurred cough, productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain; (3) signs of pulmonary consolidation and/or wet rales; (4) peripheral white blood cell count ≥10×10 9 /L or ≤4×10 9 /L with or without nuclear shift to left, while excluding some diseases with clinical manifestations similar to pneumonia, such as tuberculosis, pulmonary tumors, non-infectious interstitial lung disease, pulmonary edema, pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data. RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1-9 and score 0 groups (71.7% vs. 22.7%, 71.7% vs. 3.7%, respectively), whereas the mortality in the score≥10 group was signifi cantly higher than that in the score 1-9 and score 0 groups (16.7% vs. 4.96%, 16.7% vs. 0.3%, respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA, ACA distribution areas were signifi cantly higher than those in the SAP group and in the non-SAP group (35.1% vs.10.1%, 11.4% vs. 7.5%, respectively). The incidence of non-fermentative bacteria infection was signifi cantly increased in the score≥10 group.CONCLUSIONS: A2DS2 score provides a basis for risk stratifi cation of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.

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Development of a Clinical Score (A ² DS ² ) to Predict Pneumonia in Acute Ischemic Stroke

Cited by 190 publications

References 40 publications

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Novel Risk Score to Predict Pneumonia After Acute Ischemic Stroke

Risk assessment of ischemic stroke associated pneumonia

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Development of a Clinical Score (A 2 DS 2 ) to Predict Pneumonia in Acute Ischemic Stroke

Cited by 190 publications

References 40 publications

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

Novel Risk Score to Predict Pneumonia After Acute Ischemic Stroke

Risk assessment of ischemic stroke associated pneumonia

Contact Info

Product

Resources

About

Development of a Clinical Score (A ² DS ² ) to Predict Pneumonia in Acute Ischemic Stroke