Risk stratification model for post-stroke pneumonia in patients with acute ischemic stroke

Abstract

Background: Post-stroke pneumonia (PSP) has been implicated in the morbidity, mortality, and increased medical costs after acute ischemic stroke. Aim: The aim of this study was to develop a prediction model for PSP in patients with acute ischemic stroke. Methods: A retrospective, case-control, secondary analysis study was conducted using data for 10,034 patients with ischemic stroke who presented to the hospital within 24 hours of onset of stroke symptoms. The predictive factors for PSP were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 546 patients (5.4%) had PSP. Multivariate logistic regression revealed that age, atrial fibrillation, smoking habit, body temperature at admission, pulse rate at admission, National Institute of Health Stroke Scale (NIHSS) score upon admission, white blood cell count, and blood urea nitrogen level were major predictive factors of PSP. CART analysis identified NIHSS score at admission, pulse rate at admission, and percentage of lymphocyte as important factors for PSP to stratify the patients into subgroups. The subgroup of patients with an NIHSS score >14 at admission and pulse rate >111 beats per minute at admission and those with an NIHSS score >14, pulse rate ⩽111 beats per minute at admission, and percentage of lymphocyte ⩽9.2% had a relatively high risk of PSP (39.6% and 35.5%, respectively). Conclusions: In this study, CART analysis has a similar predictive value of PSP as compared with a logistic regression model. In addition, decision rules generated by CART can easily be interpreted and applied in clinical practice.

Dysphagia Management and Outcomes in Elderly Stroke Patients with Malnutrition Risk: Results from Chinese Stroke Center Alliance

“…Furthermore, patients with documented dysphagia screening were more likely to have a medical history (ie, atrial fibrillation, current smoking) that could increase the risk of pneumonia. 37 Meanwhile, our results demonstrate that the dysphagia status as a result of the dysphagia screening was also associated with a higher risk of in-hospital death (adjusted OR: 6.13, 95% CI: 5.18–7.27), which is consistent with other studies. 5 , 23 , 31 …”

The need for knowledge and skills in the care of post-stroke patients

“…The third article, “Risk stratification model for post-stroke pneumonia in patients with acute ischemic stroke,” deals with the development of a prediction model for post-stroke pneumonia (PSP) in patients with acute ischemic stroke. 11 Here, the authors identified factors such as the National Institute of Health Stroke Scale score at admission, pulse rate at admission, and percentage of lymphocytes, as important for stratifying the risk of PSP. Applying the risk stratification model will allow healthcare providers to recognize high-risk patients early and undertake interventions to reduce PSP.…”

Novel Predictors of Stroke-Associated Pneumonia: A Single Center Analysis

“…Therefore, the high INR at admission may be the end-point expression of the release of inflammatory factors. Secondly, a previous study found that the patients with higher INR had a more serious stroke ( 25 ) which was related to the increased risk of infection after stroke ( 11 , 28 , 29 ). Moreover, patients with severe stroke were often accompanied by reduced consciousness, which was a risk factor for SAP ( 30 ).…”