Risk factors for lung infection in stroke patients: a meta-analysis of observational studies

Yuan, Meizhen; Li, Feng; Tian, Xin; Wang, Wei; Jia, Man; Wang, Xuefeng; Liu, Guangwei

doi:10.1586/14787210.2015.1085302

Cited by 41 publications

(40 citation statements)

References 28 publications

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“…This restriction successfully identified susceptible patients, as pneumonia developed in 39% of our patients, a much higher prevalence compared with previous studies [1–3, 28]. This susceptibility probably stems from the presence of four potent risk factors of pneumonia: dysphagia [2, 14, 15, 17 18], stroke severity [2, 14–18], impaired consciousness [15, 17], and tube feeding [18, 21, 22]. All of these factors were balanced between groups in this study, the homogeneity that reduces the possibility of confounding.…”

Section: Discussionmentioning

confidence: 59%

“…This is in line with the study by J. Herzig et al [7], which demonstrated that the unadjusted and adjusted ORs of PPI for pneumonia were significantly elevated in acute stroke patients to 6.2 and 2.7, respectively. In their study, acid-suppressive drugs were more likely to be prescribed to those who had impaired consciousness and severe dysphagia, both of which are important risk factors of pneumonia in acute stroke patients [2, 14, 15, 17, 18]. Although this confounding was adjusted by multivariate analysis, there might have been some residual confounding.…”

Section: Discussionmentioning

confidence: 99%

“…To restrict the subjects so that they were homogeneous with respect to important risk factors of pneumonia, we included only those who could not feed orally (enteral feeding was permitted) for 14 days or more after admission. We chose this period because we expected that it would reliably screen for patients with dysphagia, severe neurological deficits, or impaired consciousness, all outstanding risk factors of pneumonia [2, 14–18]. Moreover, such patients would require tube feeding, also a potent risk factor of pneumonia [18, 21, 22].…”

Section: Methodsmentioning

confidence: 99%

“…We chose this period because we expected that it would reliably screen for patients with dysphagia, severe neurological deficits, or impaired consciousness, all outstanding risk factors of pneumonia [2, 14–18]. Moreover, such patients would require tube feeding, also a potent risk factor of pneumonia [18, 21, 22]. We then excluded patients who met any of the following criteria: (1) younger than 18; (2) received a prescription of H2B or PPI before admission; (3) presented pneumonia at admission; (4) under neuro-critical care including surgery and/or mechanical ventilation; (5) had incomplete medical data.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, the above studies included all patients presenting with acute stroke. Because patients with acute stroke are a heterogeneous population [2, 3, 14–18], the previous studies included patients with virtually no risk of pneumonia, as well as those with a high risk, according to recently proposed risk scores [14–17]. Although this heterogeneity was addressed using multivariate regression models, such inclusive analysis can lead to residual confounding, depending on model specification [19].…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

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Monocyte‐to‐lymphocyte ratio as a predictor of stroke‐associated pneumonia: A retrospective study‐based investigation

et al. 2021

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The impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients: A randomized controlled trial

Darwish,

El‐Tamawy,

Mahmoud

et al. 2024

Physiotherapy Res Intl

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Background and ObjectivesDysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients.MethodsA single‐blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65 years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40 min/session, 1 session/day, and 5 days/week for 4 weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4 weeks of intervention for both groups.ResultsBefore treatment, all patients were susceptible to pneumonia after two and 4 weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p < 0.05) and a statistically significant increase in incidence of SAP after 2 weeks of intervention only in the control group (p < 0.05). The results also showed a significant negative correlation between GUSS score and SAP (r = − 0.3662, p = 0.0018)Implications for Physiotherapy Practiceadding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.

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Risk factors for lung infection in stroke patients: a meta-analysis of observational studies

Abstract: Preventive measures should be taken against these risk factors to reduce the incidence of lung infection.

Cited by 41 publications

References 28 publications

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

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

Monocyte‐to‐lymphocyte ratio as a predictor of stroke‐associated pneumonia: A retrospective study‐based investigation

The impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients: A randomized controlled trial

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