Hypersensitive C‐reactive protein‐albumin ratio is associated with stroke‐associated pneumonia and early clinical outcomes in patients with acute ischemic stroke

Huang, Lingling; Zhang, Rong; Ji, Jiahui; Long, Fengdan; Wang, Yadong; Lü, Juan; Xu, Ge; Sun, Yaming

doi:10.1002/brb3.2675

Cited by 9 publications

(6 citation statements)

References 43 publications

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“…Studies have shown that stroke-related infections, especially pneumonia, are independently associated with poor functional prognosis after stroke. Our study also observed that subjects with SAP had worse functional outcomes at 3-month followup, consistent with previous studies (38)(39)(40). Two phase-II studies on prophylactic antibiotic therapy showed benefits on temperature, the incidence of infection, and even functional outcomes (41,42).…”

Section: Discussionsupporting

confidence: 93%

Inflammatory response biomarkers nomogram for predicting pneumonia in patients with spontaneous intracerebral hemorrhage

Liu

et al. 2023

Front. Neurol.

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ObjectivesInflammatory response biomarkers are promising prognostic factors to improve the prognosis of stroke-associated pneumonia (SAP) after ischemic stroke. This study aimed to investigate the prognostic significance of inflammatory response biomarkers on admission in SAP after spontaneous intracerebral hemorrhage (SICH) and establish a corresponding nomogram.MethodsThe data of 378 patients with SICH receiving conservative treatment from January 2019 to December 2021 at Taizhou People's Hospital were selected. All eligible patients were randomized into the training (70%, 265) and validation cohorts (30%, 113). In the training cohort, multivariate logistic regression analysis was used to establish an optimal nomogram, including inflammatory response biomarkers and clinical risk factors. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram's discrimination, calibration, and performance, respectively. Moreover, this model was further validated in a validation cohort.ResultsA logistic regression analysis showed that intraventricular hemorrhage (IVH), hypertension, dysphagia, Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), systemic inflammation response index (SIRI), and platelet/lymphocyte ratio (PLR) were correlated with SAP after SICH (P < 0.05). The nomogram was composed of all these statistically significant factors. The inflammatory marker-based nomogram showed strong prognostic power compared with the conventional factors, with an AUC of 0.886 (95% CI: 0.841–0.921) and 0.848 (95% CI: 0.799–0.899). The calibration curves demonstrated good homogeneity between the predicted risks and the observed outcomes. In addition, the model has a significant net benefit for SAP, according to DCA. Also, internal validation demonstrated the reliability of the prediction nomogram. The length of hospital stay was shorter in the non-SAP group than in the SAP group. At the 3-month follow-up, clinical outcomes were worse in the SAP group (P < 0.001).ConclusionSIRI and PLR at admission can be utilized as prognostic inflammatory biomarkers in patients with SICH in the upper brain treated with SAP. A nomogram covering SIRI and PLR can more accurately predict SAP in patients' supratentorial SICH. SAP can influence the length of hospital stay and the clinical outcome.

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Section: Discussionsupporting

confidence: 93%

Inflammatory response biomarkers nomogram for predicting pneumonia in patients with spontaneous intracerebral hemorrhage

Liu

et al. 2023

Front. Neurol.

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“…The diagnosis of SAP was based on the modified Centers for Disease Control and Prevention criteria of hospital-acquired pneumonia by two trained clinicians, according to clinical and laboratory parameters of acute lower respiratory tract infection, and was confirmed by chest X-ray or CT [ 6 , 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…In China, ischemic stroke serves as one of the main reasons for mortality and long-term disability in elderly people [ 1 , 2 , 3 ]. However, approximately 7–38% of acute ischemic stroke (AIS) patients suffer from stroke-associated pneumonia (SAP), which may lead to unfavorable prognosis and disability [ 4 , 5 , 6 , 7 , 8 , 9 ]. Hence, it is valuable and meaningful to explore novel biomarkers for SAP prediction in AIS patients.…”

Section: Introductionmentioning

confidence: 99%

The Association between High Mobility Group Box 1 and Stroke-Associated Pneumonia in Acute Ischemic Stroke Patients

Deng

Shi

et al. 2022

Brain Sciences

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Objective: This study aimed to investigate the association between high-mobility-group box 1 (HMGB1) and stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients. Methods: AIS patients were enrolled in two centers. The serum samples were collected within the first 24 h after admission, and HMGB1 levels were measured by enzyme-linked immunosorbent assay. Logistic regression models were used to calculate the odds ratio (OR) and 95% confidence interval (95% CI) of SAP for HMGB1 concentrations. Restricted cubic splines (RCS) were performed to explore the shapes of the association between HMGB1 concentrations and SAP. Results: From January 2022 to May 2022, a total of 420 AIS patients were enrolled. Ninety-six (22.9%) patients develop SAP. The levels of HMGB1 in the SAP group were higher than those in the non-SAP group (p < 0.001). Using the first quartile of HMGB1 group as a reference, patients in the fourth quartile of HMGB1 group had the highest likelihood of experiencing SAP in the unadjusted model (OR = 3.687; 95% CI: 1.851–7.344), age- and sex-adjusted model (OR = 3.511; 95% CI: 1.725–7.147), and multivariable-adjusted model (OR = 2.701; 95% CI: 1.045–6.981). HMGB1 was also independently associated with SAP as a continuous variable in the unadjusted model (OR = 1.132; 95% CI: 1.069–1.199), age- and sex-adjusted model (OR = 1.131; 95% CI: 1.066–1.200), and multivariable-adjusted model (OR = 1.096; 95% CI: 1.011–1.188). RCS showed a linear association between HMGB1 and SAP (p for linear trend = 0.008) Conclusions: HMGB1 might be able to act as a potential biomarker of SAP in AIS patients.

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“…Consequently, biomarkers implicated in immune alterations and systemic inflammatory responses may play a role in SAP development. Studies have linked parameters such as white blood cell count, neutrophil count, lymphocyte count, as well as inflammatory biomarkers like the monocyte-to-lymphocyte ratio and the C-reactive protein albumin ratio, to adverse outcomes in SAP episodes and stroke 4 , 5 . Malnutrition is common among patients with ICH and is linked to higher risks of all-cause mortality and unfavorable functional outcomes 6 .…”

Section: Introductionmentioning

confidence: 99%

The clinical value of nutritional and inflammatory indicators in predicting pneumonia among patients with intracerebral hemorrhage

Zhao,

Chen,

et al. 2024

Sci Rep

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Immunosuppression and malnutrition play pivotal roles in the complications of intracerebral hemorrhage (ICH) and are intricately linked to the development of stroke-associated pneumonia (SAP). Inflammatory markers, including NLR (neutrophil-to-lymphocyte ratio), SII (systemic immune inflammation index), SIRI (systemic inflammatory response index), and SIS (systemic inflammation score), along with nutritional indexes such as CONUT (controlling nutritional status) and PNI (prognostic nutritional index), are crucial indicators influencing the inflammatory state following ICH. In this study, our objective was to compare the predictive efficacy of inflammatory and nutritional indices for SAP in ICH patients, aiming to determine and explore their clinical utility in early pneumonia detection. Patients with severe ICH requiring ICU admission were screened from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The outcomes included the occurrence of SAP and in-hospital death. Receiver operating characteristic (ROC) analysis, multivariate logistic regression, smooth curve analysis, and stratified analysis were employed to investigate the relationship between the CONUT index and the clinical outcomes of patients with severe ICH. A total of 348 patients were enrolled in the study. The incidence of SAP was 21.3%, and the in-hospital mortality rate was 17.0%. Among these indicators, multiple regression analysis revealed that CONUT, PNI, and SIRI were independently associated with SAP. Further ROC curve analysis demonstrated that CONUT (AUC 0.6743, 95% CI 0.6079–0.7408) exhibited the most robust predictive ability for SAP in patients with ICH. Threshold analysis revealed that when CONUT < 6, an increase of 1 point in CONUT was associated with a 1.39 times higher risk of SAP. Similarly, our findings indicate that CONUT has the potential to predict the prognosis of patients with ICH. Among the inflammatory and nutritional markers, CONUT stands out as the most reliable predictor of SAP in patients with ICH. Additionally, it proves to be a valuable indicator for assessing the prognosis of patients with ICH.

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Hypersensitive C‐reactive protein‐albumin ratio is associated with stroke‐associated pneumonia and early clinical outcomes in patients with acute ischemic stroke

Cited by 9 publications

References 43 publications

Inflammatory response biomarkers nomogram for predicting pneumonia in patients with spontaneous intracerebral hemorrhage

Inflammatory response biomarkers nomogram for predicting pneumonia in patients with spontaneous intracerebral hemorrhage

The Association between High Mobility Group Box 1 and Stroke-Associated Pneumonia in Acute Ischemic Stroke Patients

The clinical value of nutritional and inflammatory indicators in predicting pneumonia among patients with intracerebral hemorrhage

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