SDL Index Predicts Stroke-Associated Pneumonia in Patients After Endovascular Therapy

Abstract

Objective: This study aimed to develop and validate a novel index to predict SAP for AIS patients who underwent endovascular treatment.Methods: A study was conducted in an advanced comprehensive stroke center from January 2013 to December 2019 aiming to develop and validate a novel index to predict SAP for AIS patients who underwent endovascular treatment. This cohort consisted of a total of 407 consecutively registered AIS patients who underwent endovascular therapy, which was divided into derivation and validation cohorts. Multiple blood parameters as well as demographic features, vascular risk factors, and clinical features were carefully evaluated in the derivation cohort. The independent predictors were obtained using multivariable logistic regression. The scoring system was generated based on the β-coefficients of each independent risk factor.Results: Ultimately, a novel predictive model: the SDL index (stroke history, dysphagia, lymphocyte count < 1.00 × 103/μL) was developed. The SDL index showed good discrimination both in the derivation cohort (AUROC: 0.739, 95% confidence interval, 0.678–0.801) and the validation cohort (AUROC: 0.783, 95% confidence interval, 0.707–0.859). The SDL index was well-calibrated (Hosmer–Lemeshow test) in the derivation cohort (P = 0.389) and the validation cohort (P = 0.692). We therefore divided our population into low (SDL index = 0), medium (SDL index = 1), and high (SDL index ≥ 2) risk groups for SAP. The SDL index showed good discrimination when compared with two existing SAP prediction models.Conclusions: The SDL index is a novel feasible tool to predict SAP risk in acute ischemic stroke patients post endovascular treatment.

The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis

“…This systematic review included 25 studies, of which 12 were retrospective [ 10 , 12 , 14 , 18 , 22 – 25 , 28 , 30 – 32 ] and 13 were prospective [ 4 , 9 , 11 , 13 , 15 – 17 , 19 – 21 , 26 , 27 , 29 ]. Among 25 studies, 15 were included in the meta-analysis; nine were retrospective [ 10 , 14 , 22 , 24 , 25 , 28 , 30 – 32 ], and six were prospective [ 11 , 13 , 20 , 26 , 27 , 29 ]. In terms of document language, all of the documents were written in the English language.…”

“…In subgroup analysis according to study design, there were six retrospective studies [ 10 , 14 , 25 , 28 , 30 , 32 ] with 3,263 patients with stroke, 458 of whom got PSP, and three prospective studies [ 13 , 26 , 29 ] with 731 patients with stroke, 157 of whom got PSP. In both retrospective and prospective studies, the NLR levels in the PSP group were substantially higher than those in the NPSP group (SMD = 0.94, CI 95% = 0.75‐1.13, P value < 0.001 and SMD = 1.07, CI 95% = 0.74‐1.39, P value < 0.001, respectively) ( Figure 5 ).…”

“…In addition, the scale named NOS was used to assess the quality of the included research (Tables 1 and 2). In total, six studies compared NLR levels in PSI patients and controls [11,20,22,24,27,31], and nine studies reported NLR levels in the PSP group against controls [10,13,14,25,26,[28][29][30]32].…”

“…Level in Patients with and without PSP. In 9 studies [10,13,14,25,26,[28][29][30]32] with 3,994 stroke patients, of whom 615 were eventually diagnosed with PSP, NLR levels in the PSP group were compared to those in the nonpoststroke pneumonia (NPSP) group. The NLR levels of the PSP groups were significantly higher than those of the NPSP group (SMD = 0:98; CI 95% = 0:81-1:14, P value < 0.001).…”

“…In another subgroup analysis according to study region, there were seven studies [10,13,25,[28][29][30]32] in East Asia including 3,385 patients with stroke, of whom 509 had PSP, and two studies [14,26] in Europe including 609 patients with stroke, of whom 106 developed PSP. In the studies in both East Asia and Europe, the NLR levels in patients with PSP were significantly higher than those in patients with NPSP (SMD = 1:02, CI 95% = 0:84-1:20, P value < 0.001 and SMD = 0:77, CI 95% = 0:48-1:07, P value < 0.001, respectively) (Figure 6).…”