Can a Novel Clinical Risk Score Improve Pneumonia Prediction in Acute Stroke Care? A UK Multicenter Cohort Study

Smith, Craig J.; Bray, Benjamin; Hoffman, Alex; Meisel, Andreas; Heuschmann, Peter U.; Wolfe, Charles; Tyrrell, Pippa J.; Rudd, Anthony

doi:10.1161/jaha.114.001307

Cited by 133 publications

(173 citation statements)

References 30 publications

Supporting

Mentioning

145

Contrasting

Unclassified

Order By: Relevance

“…Second, we also confirmed that SAP is correlated with poor outcomes in the aspects of hospitalization duration, neurological function and mortality, continued to previous study [2, 3]. We also have several limitations.…”

Section: Discussionsupporting

confidence: 87%

Leukoaraiosis is associated with pneumonia after acute ischemic stroke

et al. 2017

View full text Add to dashboard Cite

BackgroundStroke-associated pneumonia (SAP) is common in patients with acute ischemic stroke, and several risk factors have been reported. However, the relationship between underlying leukoaraiosis (LA) and SAP has not been addressed.MethodsWe collected consecutive patients with acute ischemic stroke within 24 h of symptom onset. SAP was defined as the lower respiratory tract infection within the first 7 days after stroke onset, according to the modified Centers for Disease Control and Prevention criteria. LA was graded using the Fazekas scale in both the periventricular and subcortical areas. We evaluated LA burden by summing the grade and dichotomized into mild LA (0–2) or severe LA (3–6). Relationship between LA and SAP was analyzed by binary logistic regression analysis with variables of P < 0.05 in univariate analysis.ResultsThree hundred eight consecutive patients were enrolled, and SAP developed in 44 patients (14%). Univariate analysis revealed that SAP correlated with age, initial NIHSS score, atrial fibrillation, impaired consciousness, dysphagia, severe LA and hyperlipidemia. On multivariate analysis, severe LA [adjusted OR (aOR) = 4.41, 95% CI = 2.04–9.55, P < 0.001 remained independent predictors of SAP after adjusted confounders.ConclusionsIn this study, LA was an independent predictor of SAP. This observation needs to be confirmed in suitably-designed, prospective studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-017-0830-5) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionsupporting

confidence: 87%

Leukoaraiosis is associated with pneumonia after acute ischemic stroke

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This rate is low compared to other publications (e.g. [4]) and is probably due to the dietary recommendations of GUSS.…”

contrasting

confidence: 72%

Overestimating the risk of aspiration in acute stroke

Trapl

Teuschl

Matz

et al. 2017

Euro J of Neurology

View full text Add to dashboard Cite

“…Another limitation of our study is that we could not obtain reliable information about pre-stroke dependence, one of the reported risk factors of pneumonia in acute stroke [2, 14–16], although we measured other important previously reported risk factors.…”

Section: Discussionmentioning

confidence: 99%

Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients

et al. 2017

View full text Add to dashboard Cite

BackgroundAlthough histamine H2-blockers (H2B) and proton pump inhibitors (PPI) are used commonly to prevent gastrointestinal bleeding in acute stroke, they are implicated in the increased risk of pneumonia in other disease populations. In acute stroke, the presence of distinctive risk factors of pneumonia, including dysphagia and impaired consciousness, makes inclusive analysis vulnerable to confounding. Our aim was to assess whether acid-suppressive drugs increase pneumonia in acute stroke in a population controlled for confounding.MethodsWe analyzed acute stroke patients admitted to a tertiary care hospital. To minimize confounding, we only included subjects who could not feed orally during 14 days of hospitalization. Exposure was defined as H2B or PPI, given in days; the outcome was development of pneumonia within this period. The incidence was calculated from the total number of pneumonias divided by the sum of person-days at risk. We additionally performed multivariate Poisson regression and propensity score analyses, although the restriction largely eliminated the need for multivariate adjustment.ResultsA total of 132 pneumonias occurred in 3582 person-days. The incidence was 3.69%/person-day (95% confidence interval (CI); 3.03–4.37%/day). All subjects had dysphagia. Stroke severity and consciousness disturbances were well-balanced between the groups exposed to H2B, PPI, or none. The relative risk (RR) compared with the unexposed was 1.22 in H2B (95%CI; 0.83–1.81) and 2.07 in PPI (95% CI; 1.13–3.62). The RR of PPI compared with H2B was 1.69 (95%CI; 0.95–2.89). In multivariate regression analysis, the RRs of H2B and PPI were 1.24 (95% CI; 0.85–1.81) and 2.00 (95% CI; 1.12–3.57), respectively; in propensity score analyses they were 1.17 (95% CI; 0.89–1.54) and 2.13 (95% CI; 1.60–2.84).ConclusionsThe results of this study suggested that prophylactic acid-suppressive therapy with PPI may have to be avoided in acute stroke patients susceptible to pneumonia.

show abstract

Can a Novel Clinical Risk Score Improve Pneumonia Prediction in Acute Stroke Care? A UK Multicenter Cohort Study

Cited by 133 publications

References 30 publications

Leukoaraiosis is associated with pneumonia after acute ischemic stroke

Leukoaraiosis is associated with pneumonia after acute ischemic stroke

Overestimating the risk of aspiration in acute stroke

Histamine H2-Blocker and Proton Pump Inhibitor Use and the Risk of Pneumonia in Acute Stroke: A Retrospective Analysis on Susceptible Patients

Contact Info

Product

Resources

About