Novel Risk Score to Predict Pneumonia After Acute Ischemic Stroke

Abstract

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.

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

“…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.…”

“…[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.…”

Predictors of pneumonia in acute stroke in patients in an emergency unit

“…Ruijun et al 22 showed that age, atrial fibrillation, congestive heart failure, chronic obstructive pulmonary disease and current smoking, prestroke dependence, dysphagia, admission NIHSS and GCS scores, stroke subtype and blood glucose were independent predictors of pneumonia in ischemic stroke. Finlayson et al 23 indicated that male sex, nonlacunar ischemic stroke, and preadmission dependency were predictors too.…”

Impact of Admission Hyperglycemia on Stroke-Associated Pneumoniain Acute Cerebral Hemorrhage: A Retrospective Observational Study

“…Identifying swallowing impairments, implementing dietary modification, head elevation, and shortened use of mechanical ventilation have been emphasized [32] [33]. Other investigators have developed tools for identifying patients at high risk for SAP, although it is unclear how this informs patient care at present [34] [35]. Our finding showed that hyperglycemia especially hyperglycemia with normal HgbA1C level were an independent risk factor for SAP in acute phase of ICH.…”

“…Hyperglycemia on admission is a well-known predictor of poor outcome in patients with ICH [11] [12]. Recently, there are few small studies have examined the relationship between blood glucose levels and post-stroke infection [13] [14]. No larger studies have examined the incidence of SAP or their impact on outcome in a pure ICH cohort.…”