Predictors of mortality and disability in stroke-associated pneumonia

Tinker, Rory J; Smith, Craig J.; Heal, Calvin; Bettencourt‐Silva, Joao H.; Metcalf, Anthony K.; Potter, John F.; Myint, Phyo Kyaw

doi:10.1007/s13760-019-01148-w

Cited by 40 publications

(39 citation statements)

References 24 publications

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“…33 In this study, stroke patients over the age of 65 had 6.3 times the risk of dying (AHR=6.3, 95% CI: 1.74-22.74) as those under the age of 45. This is similar to two studies conducted in Iran, 18,45 in United States, 52,53 UK, 40 Kenya, 43 older age was the predictors of mortality. The survival difference between young and older stroke Whereas study in Ethiopia 50,54 shows age has no association with mortality.…”

Section: Discussionsupporting

confidence: 89%

“…This finding is consistent with a 15.7% survival rate in Finland, 39 a 37-month FHCSH survival rate after 36 months of follow-up, 39 thirty-seven month survival rate FHCSH after thirty-six follow-up, 37 and a month-long analysis and systematic review study in the United Kingdom. 40,41 But the survival rate of twelve months in this study is higher than the result reported (79.2%) in Lithuania, 42 59.3% in Kenya. 43 The disparity may be explained by the sample size difference, with inclusion criteria for an age range of 25-64 years in Lithuania and 719 study participants across three hospitals in Kenya, whereas our study is a single hospital-based study.…”

Section: Discussioncontrasting

confidence: 73%

“…24 In Ethiopia, the burden of stroke is increasing and has become the reason for 7.5% to 19.3% of hospital admission, 5,8,14,20,39 and approximately (11% to 42.8%) death between (2014-2019). 5,8,11,13,20,27,33,[40][41][42][43][44][45] Among the consequences of stroke were, among others, sudden death and depression (12.4% to 42.9%). 13,25 The wide range of medical complications of stroke are 16.5% to 27.6% of brain edema, 26,27 22.9% speech alteration, 3.5% bedsores, deep venous thrombosis (DVT) 4.1% because of immobility from stroke, 13 increased intracranial pressure (16.5%_26.1%) infection 5.9-21.1% and Seizure.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Survival Status and Predictors of Mortality Among Stroke Patients at North West Ethiopia

Walelgn¹,

Abyu²,

Seyoum³

et al. 2021

RMHP

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Introduction: Stroke is one of the commonest non-communicable disease types that has a great public health impact both in developed and developing countries. However, in Ethiopia, the long-term survival status of stroke patients is not very understood. This study aimed at assessing survival status and predictors of mortality among stroke patients at Felege Hiwot comprehensive specialized hospital from September 1, 2014, to August 31, 2019, Bahirdar, North West Ethiopia. Methods: An institutional-based retrospective cohort study was conducted using 368 registered stroke patients between September 1, 2014, and August 31, 2019. We used Kaplan-Meier together with a Log-rank test to compare the survival rate of the study participants using categorical variables and to compare covariate and both bi-variable and multivariable Cox proportional hazards regression analysis model was conducted to identify predictors of mortality among stroke patients. The association between outcome and independent variables was expressed using an adjusted hazard ratio (AHR) with a 95% confidence interval and statistical significances were declared at P-value of <0.05. Results: Fifty-six (15.2%) of the 368 stroke patients included in the study died, and 312 (84.8%) were correctly censored. The overall survival rate was 72.2% at 51 months of follow-up with a median survival time of 0.26 months. Age greater than 65 (AHR 6.31, 95% CI 1.75-22.74), body temperature >7.1 degree centigrade (AHR = 7.14, 95% CI: 2.76-18.5), potassium level below <2 mmol/l (AHR = 2, 95% CI: 1.9-23.53) and creatinine level >1.2 mg/dl (AHR = 7.85, 95% CI: 2.7-22.6) were predictive predictors of mortality. Conclusions: In the follow-up of 51 months, significant mortality occurred. Important predictive predictors of survival status were identified. Interventions should be focused on health education and awareness creation of the community for the early management of stroke.

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Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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The Survival Status and Predictors of Mortality Among Stroke Patients at North West Ethiopia

Walelgn¹,

Abyu²,

Seyoum³

et al. 2021

RMHP

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“…Recently, it was reported that elevated serum levels of CRP could be a predictor for post-stroke disability and prognosis (46) as well as a diagnostic marker for stroke-associated pneumonia (47,48). In the present study, median CRP serum levels were found to be significantly increased in pneumonia patients from the BL investigation timepoint, reaching a plateau at 48 h and decreasing again till the 120-h investigation.…”

Section: Immunological Datasupporting

confidence: 56%

Oral Health, Oral Microbiota, and Incidence of Stroke-Associated Pneumonia—A Prospective Observational Study

et al. 2020

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Stroke-associated pneumonia is a major cause for poor outcomes in the post-acute phase after stroke. Several studies have suggested potential links between neglected oral health and pneumonia. Therefore, the aim of this prospective observational study was to investigate oral health and microbiota and incidence of pneumonia in patients consecutively admitted to a stroke unit with stroke-like symptoms. This study involved three investigation timepoints. The baseline investigation (within 24 h of admission) involved collection of demographic, neurological, and immunological data; dental examinations; and microbiological sampling (saliva and subgingival plaque). Further investigation timepoints at 48 or 120 h after baseline included collection of immunological data and microbiological sampling. Microbiological samples were analyzed by culture technique and by 16S rRNA amplicon sequencing. From the 99 patients included in this study, 57 were diagnosed with stroke and 42 were so-called stroke mimics. From 57 stroke patients, 8 (14%) developed pneumonia. Stroke-associated pneumonia was significantly associated with higher age, dysphagia, greater stroke severity, embolectomy, nasogastric tubes, and higher baseline C-reactive protein (CRP). There were trends toward higher incidence of pneumonia in patients with more missing teeth and worse oral hygiene. Microbiological analyses showed no relevant differences regarding microbial composition between the groups. However, there was a significant ecological shift over time in the pneumonia patients, probably due to antibiotic treatment. This prospective observational study investigating associations between neglected oral health and incidence of SAP encourages investigations in larger patient cohorts and implementation of oral hygiene programs in stroke units that may help reducing the incidence of stroke-associated pneumonia.

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“…Our study had some limitations that deserve comment. First, as a retrospective study, we cannot rule out the possibility that additional baseline variables (unmeasured confounders) might have some impact on the development of post-stroke pneumonia, such as dementia [31,32], the use of angiotensin receptor blockers or the use of angiotensin-converting enzyme inhibitors [33]. Second, the time course for post-stroke pneumonia was unclear.…”

Section: Discussionmentioning

confidence: 99%

Braden Scale for Assessing Pneumonia After Acute Ischaemic Stroke

Ding

Yan

Niu

et al. 2019

Preprint

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Background The prevention of pneumonia is critical for patients with acute ischaemic stroke (AIS). The six subscales in the Braden Scale seem to be related to the occurrence of pneumonia. We aimed to evaluate the feasibility of using the Braden Scale to predict the occurrence of pneumonia after AIS.Methods We studied a series of consecutive patients with AIS who were admitted to the hospital. The cohort was subdivided into pneumonia and no pneumonia groups. The scores on the Braden Scale, demographic characteristics and clinical characteristics were obtained and analysed by statistical comparisons between the two groups. We investigated the predictive validity of the Braden Scale by receiver operating characteristic (ROC) curve analysis.Results A total of 414 patients with AIS were included in this study. Of those 414 patients, 57 (13.8%) patients fulfilled the criteria for post-stroke pneumonia. There were significant differences in age and histories of chronic obstructive pulmonary disease (COPD), dysphagia and Glasgow Coma Scale (GCS) score between the two groups, and the National Institutes of Health Stroke Scale (NIHSS) score in the pneumonia group was significantly higher than that in the no pneumonia group ( P <0.01). The mean score on the Braden Scale in the pneumonia group was significantly lower than that in the no pneumonia group ( P < 0.01). The six subscale scores on the Braden Scale were all significantly different between the two groups. The area under the curve (AUC) for the Braden Scale for the prediction of pneumonia after AIS was 0.883 (95% CI = 0.828-0.937). With 18 points as the cutoff point, the sensitivity was 83.2%, and the specificity was 84.2%.Conclusion The Braden Scale with 18 points as the cutoff point is likely a valid clinical grading scale for predicting pneumonia after AIS at presentation. Further studies on the association of the Braden Scale score with stroke outcomes are needed.

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Predictors of mortality and disability in stroke-associated pneumonia

Cited by 40 publications

References 24 publications

The Survival Status and Predictors of Mortality Among Stroke Patients at North West Ethiopia

The Survival Status and Predictors of Mortality Among Stroke Patients at North West Ethiopia

Oral Health, Oral Microbiota, and Incidence of Stroke-Associated Pneumonia—A Prospective Observational Study

Braden Scale for Assessing Pneumonia After Acute Ischaemic Stroke

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