Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke

Finlayson, Olga; Kapral, Moira K.; Hall, Ruth; Asllani, Eriola; Selchen, Daniel; Saposnik, Gustavo

doi:10.1212/wnl.0b013e31823152b1

Cited by 351 publications

(342 citation statements)

References 30 publications

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“…19,20 Older age, stroke severity, and preadmission dependency additionally increase the risk of stroke-related pneumonia, which also strongly predicts poor outcome. 21 According to our data, 3-month mortality is higher with every level of prestroke disability, starting from 28% (preexisting mRS of 1) up to 48% (preexisting mRS of 3-5). Trends for achieving favorable outcome are obviously the opposite.…”

Section: Discussionmentioning

confidence: 55%

Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke

Karliñski

Kobayashi

Członkowska

et al. 2014

Stroke

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Background and Purpose— Little is known about the effect of thrombolysis in patients with preexisting disability. Our aim was to evaluate the impact of different levels of prestroke disability on patients’ profile and outcome after intravenous thrombolysis. Methods— We analyzed the data of all stroke patients admitted between October 2003 and December 2011 that were contributed to the Safe Implementation of Treatments in Stroke–Eastern Europe (SITS-EAST) registry. Patients with no prestroke disability at all (modified Rankin Scale [mRS] score, 0) were used as a reference in multivariable logistic regression. Results— Of 7250 patients, 5995 (82%) had prestroke mRS 0, 791 (11%) had prestroke mRS 1, 293 (4%) had prestroke mRS 2, and 171 (2%) had prestroke mRS ≥3. Compared with patients with mRS 0, all other groups were older, had more comorbidities, and more severe neurological deficit on admission. There was no clear association between preexisting disability and the risk of symptomatic intracranial hemorrhage. Prestroke mRS 1, 2, and ≥3 were associated with increased risk of death at 3 months (odds ratio, 1.3, 2.0, and 2.6, respectively) and lower chance of achieving favorable outcome (achieving mRS 0–2 or returning to the prestroke mRS; 0.80, 0.41, 0.59, respectively). Patients with mRS ≥3 and 2 had similar vascular profile and favorable outcome (34% versus 29%), despite higher mortality (48% versus 39%). Conclusions— Prestroke disability does not seem to independently increase the risk of symptomatic intracranial hemorrhage after thrombolysis. Despite higher mortality, 1 in 3 previously disabled patients may return to his/her prestroke mRS. Therefore, they should not be routinely excluded from thrombolytic therapy.

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Section: Discussionmentioning

confidence: 55%

Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke

Karliñski

Kobayashi

Członkowska

et al. 2014

Stroke

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Almeida

Bahia

Lima

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years) were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001), higher National Institute of Health Stroke Scale (NIHSS) (p = 0.047) and, lower Glasgow Coma Score (GCS) (p < 0.0001). Patients with pneumonia had longer hospitalization (p < 0.0001). Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002). Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

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“…For example, the risk of pneumonia is increased in functionally impaired, and decreased in mobile subjects engaged in daily activity (walking >0.5‐1 h/d) 9. Pneumonia is the most common clinical complication after stroke, and stroke severity was an independent risk factor for pneumonia in a retrospective cohort study 10. Moreover, pneumonia could be prevented in patients with acute stroke by adding a passive turning and mobilization program to usual care 11.…”

Section: Introductionmentioning

confidence: 99%

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

Grimnes

Isaksen

Tichelaar

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials There is a bidirectional relation between acute infections and immobilizationWe studied the impact of infection and immobilization on risk of VTE in a case‐crossover designAcute infection was a strong trigger for VTE independent of concomitant immobilizationInfection and immobilization had a synergistic effect on the VTE‐risk BackgroundA bidirectional relation exists between acute infection and immobilization, and both are triggers for venous thromboembolism (VTE). To what extent the association between infection and VTE‐risk is explained by immobilization is unknown.AimsTo investigate the impact of hospitalization with acute infection on the VTE‐risk in patients with and without concomitant immobilization, and to explore the differential impact of respiratory‐ (RTI) and urinary‐ (UTI) tract infections on the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).MethodsWe conducted a case‐crossover study of VTE‐patients (n = 707) recruited from a general population. Hospitalizations and VTE‐triggers were registered during the 90 days before a VTE (hazard period) and in four preceding 90‐day control periods. Conditional logistic regression was used to estimate odds ratios (ORs) for VTE according to triggers.ResultsAcute infection was registered in 267 (37.8%) of the hazard periods and in 107 (3.8%) of the control periods, corresponding to a high VTE‐risk after infection (OR 24.2, 95% CI 17.2‐34.0), that was attenuated to 15‐fold increased after adjustment for immobilization. The risk was 20‐fold increased after infection without concomitant immobilization, 73‐fold increased after immobilization without infection, and 141‐fold increased with the two combined. The risk of PE was apparently higher after RTIs (OR 48.3, 95% CI 19.4‐120.0) than UTIs (OR 12.6, 95% CI 6.4‐24.7), but diminished in sensitivity analyses excluding uncertain RTI diagnoses.ConclusionsOur findings suggest that hospitalization with infection is a strong VTE‐trigger also in non‐immobilized patients. Infection and immobilization had a synergistic effect on the VTE‐risk.

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Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke

Abstract: Development of pneumonia after stroke was associated with mortality at 30 days and 1 year, longer length of stay, and dependency at discharge. Patients who received more inpatient stroke services had reduced mortality after pneumonia.

Cited by 351 publications

References 30 publications

Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke

Role of Preexisting Disability in Patients Treated With Intravenous Thrombolysis for Ischemic Stroke

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

Acute infection as a trigger for incident venous thromboembolism: Results from a population‐based case‐crossover study

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