Risk assessment of ischemic stroke associated pneumonia

Abstract

BACKGROUND: Cerebral stroke is a disease with a high disability rate and a high fatality rate. This study was undertaken to assess the risk of stroke associated pneumonia (SAP) in patients with ischemic stroke using A2DS2 score. METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows: age ≥75 years=1, atrial fi brillation=1, dysphagia=2, male sex=1; stroke severity: NIHSS score 0-4=0, 5-15=3, ≥16=5. The patients were divided into three groups according to A2DS2 score: 620 in score 0 group, 383 in score 1-9 group, and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows: newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection: (1) fever ≥38 °C; (2) newly occurred cough, productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain; (3) signs of pulmonary consolidation and/or wet rales; (4) peripheral white blood cell count ≥10×10 9 /L or ≤4×10 9 /L with or without nuclear shift to left, while excluding some diseases with clinical manifestations similar to pneumonia, such as tuberculosis, pulmonary tumors, non-infectious interstitial lung disease, pulmonary edema, pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data. RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1-9 and score 0 groups (71.7% vs. 22.7%, 71.7% vs. 3.7%, respectively), whereas the mortality in the score≥10 group was signifi cantly higher than that in the score 1-9 and score 0 groups (16.7% vs. 4.96%, 16.7% vs. 0.3%, respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA, ACA distribution areas were signifi cantly higher than those in the SAP group and in the non-SAP group (35.1% vs.10.1%, 11.4% vs. 7.5%, respectively). The incidence of non-fermentative bacteria infection was signifi cantly increased in the score≥10 group.CONCLUSIONS: A2DS2 score provides a basis for risk stratifi cation of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.

Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke

“…33 Pneumonia is one of the most frequent medical complications of stroke and is associated with poor prognosis. 34 Frequently, pneumonia occurs in the acute phase of stroke and can increase mortality rates, hospitalization times, and hospital costs. 35 The predictors for the occurrence of pneumonia in ischemic stroke patients with dysphagia in the present study were age, NIHSS score, and the laryngeal penetration of liquid.…”

Excessive antibiotics use increased in-hospital mortality in intracerebral hemorrhage patients with stroke-associated infection

“…It may be that the NIHSS score more comprehensively reflects neurological impairment due to hematoma volume and impaired consciousness captured in the GCS score. In any event, our findings and the literature highlight the need for clinicians to pay sufficient attention to patients with intracerebral hemorrhage, regardless of the severity of their neurological deficits, including timely assessment of swallowing function 32 , retention of the gastric tube 33 and effective counseling and other interventions to help patient's family members prevent SAI. At the same time, risks and benefits of antibiotic use should be weighed carefully 34 .…”

Uji Validasi Skor A2DS2 sebagai Prediktor Insiden Pneumonia pada Pasien Stroke Iskemik Akut

“…Dengan demikian, identifikasi dini pasien-pasien stroke dengan risiko tinggi mengalami pneumonia dapat membantu dokter dalam mencegah timbulnya pneumonia kepada pasien-pasien stroke selama perawatan di rumah sakit. 3,4 Berbagai penelitian telah melaporkan faktor-faktor yang berhubungan dengan timbulnya pneumonia terkait stroke pada pasien-pasien stroke iskemik akut, seperti usia lanjut, jenis kelamin (laki-laki), tingkat keparahan stroke yang berat berdasarkan skor NIHSS, disfagia, penurunan kesadaran, komorbiditas seperti hipertensi, diabetes melitus, dan lain-lain. 5,6 Berdasarkan faktor-faktor risiko yang telah diketahui ini, berbagai sistem skor telah diciptakan untuk membantu para klinisi dalam mengenal dan menentukan stratifikasi risiko pasien-pasien stroke iskemik akut terhadap timbulnya pneumonia selama perawatan di RS.…”