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

Abstract

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.

Risk factors for pneumonia in acute stroke patients admitted to the Emergency Department of a Tertiary Government Hospital

“…Findings of the study showed that smoking, alcohol intake, dysphagia, age, hemorrhagic type of stroke, and need for intubation were factors independently increased the risk for developing pneumonia. Age, dysphagia, hemorrhagic stroke, and need for intubation have all been previously reported as risk factors for stroke-associated pneumonia, [1,4,5,[9][10][11][12][13] which is consistent with our findings. However, this study identified another risk factor not yet reported in literature which is alcohol intake, but the data on the amount and duration of alcohol intake were not obtained.…”

“…Hemorrhagic stroke patients are more likely to develop pneumonia than those of ischemic stroke patients. [1] Furthermore, the need for intubation from respiratory failure is greater in hemorrhagic stroke (30% compared to 6% in ischemic stroke). [5] Dysphagia is a common complication of acute stroke, present in more than 50% of stroke survivors.…”

“…[1] However, sample size was increased to 336 with equal allocation of patients in the case and control groups. Simple random sampling was employed in obtaining the 168 cases and 168 controls.…”

“…A lot of patients are received with a relative risk of 3.0 for mortality. [1] Pneumonia can be classified as (a) community-acquired pneumonia (CAP), (b) nosocomial pneumonia (hospital-acquired pneumonia or ventilator-associated pneumonia), and (c) healthcare-associated pneumonia. [2] Pneumonia that is acquired out of the hospitals is termed as CAP while nosocomial pneumonia is classified further into hospital-acquired and ventilator-associated pneumonia.…”

“…[3] Other risk factors include older age, diabetes, cognitive impairment, stroke severity, [4] and modified Rankin scale (mRS) score ≥4. [5] Stroke severity as measured using the National Institute of Health Stroke Scale (NIHSS) score is the only factor associated with pneumonia, [1] and is a predictor of poor outcome. [6] The increasing length of stay (>5 h) at the emergency department was found to worsen the neurologic outcome but not mortality.…”