The effect of pneumonia on mortality among patients hospitalized for acute stroke

Katzan, Irene; Cebul, Randall D.; Husak, Scott; Dawson, Neal V.; Baker, David W.

doi:10.1212/01.wnl.0000046586.38284.60

Cited by 489 publications

(396 citation statements)

References 26 publications

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“…This is best done in a dedicated stroke unit with experienced staff and early mobilization 12,13,14 . Pneumonia is the leading cause of death in the post-acute phase of stroke 6 . The majority of the pneumonias are caused by aspiration but there are other reasons that include hypostatic pneumonia due to poor caring and immobilization.…”

Section: Discussionmentioning

confidence: 99%

“…Our cohort showed the relationship between pneumonia and hemorrhagic stroke, probably because these patients had more complications during the hospitalization and more deaths than ischemic group. Some studies have demonstrated that complications such as stroke progression or pneumonia adversely affect clinical outcome 6,17 . Increase risk of poor outcome in patients with pneumonia, if unadjusted, reflects not only the effect of pneumonia but the effect of other factors predisposing them to pneumonia, such as initial stroke severity or neurological complications.…”

Section: Discussionmentioning

confidence: 99%

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

Almeida

Bahia

Lima

et al. 2015

Arq. Neuro-Psiquiatr.

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Almeida

Bahia

Lima

et al. 2015

Arq. Neuro-Psiquiatr.

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“…Cerebral stroke and concurrent pneumonia may increase the fatality rate of patients in 30 days by 4 folds, extend the length of hospital stay by 3 folds, and result in a sharp increase of medical expenses. [5][6][7] The clinical features of SAP are:…”

Section: Discussionmentioning

confidence: 99%

Risk assessment of ischemic stroke associated pneumonia

Li¹,

Zhang²,

Wu-ping³

et al. 2014

World Journal of Emergency Medicine

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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.

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“…14 In our study, especially animals with signs of infection had a lower chance for survival, which is corresponding to the clinical Preventive antibiotic treatment in experimental stroke S Hetze et al situation, where mortality is approximately threefold higher in infected patients than in noninfected. 4 Especially, pneumonia is one of the most prominent reasons for death after stroke. 3,31 Clinical evidence and animal experiments indicate weight loss as a common phenomenon after stroke, and several pathways of metabolic imbalance were proposed to contribute to this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Superiority of Preventive Antibiotic Treatment Compared with Standard Treatment of Poststroke Pneumonia in Experimental Stroke: A Bed to Bench Approach

Hetze

Engel

Römer

et al. 2013

J Cereb Blood Flow Metab

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Stroke patients are prone to life-threatening bacterial pneumonia. Previous experimental stroke studies have demonstrated that preventive antibiotic treatment (PAT) improves outcome compared with placebo treatment, which however does not model the clinical setting properly. Here we investigate whether PAT is superior to the current clinical 'gold standard' for treating poststroke infections. Therefore, we modeled stroke care according to the current stroke guidelines recommending early antibiotic treatment after diagnosing infections. To reliably diagnose pneumonia in living mice, we established a general health score and a magnetic resonance imaging protocol for radiologic confirmation. Compared with standard treatment after diagnosis by these methods, PAT not only abolished pneumonia successfully but also improved general medical outcome. Both, preventive and standard antibiotic treatment using enrofloxacin improved survival in a similar way compared with placebo treatment. However, in contrast to standard treatment, only PAT improved functional outcome assessed by gait analysis. In conclusion, standard and preventive treatment approach reduced poststroke mortality, however at the cost of a worse neurologic outcome compared with preventive approach. These data support the concept of PAT for treating patients at risk for poststroke infections and warrant phase III trials to prove this concept in clinical setting.

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The effect of pneumonia on mortality among patients hospitalized for acute stroke

Abstract: In this large community-wide study of stroke outcomes, pneumonia conferred a threefold increased risk of 30-day death, adding impetus to efforts to identify and reduce the risk of pneumonia in patients with stroke.

Cited by 489 publications

References 26 publications

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

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

Risk assessment of ischemic stroke associated pneumonia

Superiority of Preventive Antibiotic Treatment Compared with Standard Treatment of Poststroke Pneumonia in Experimental Stroke: A Bed to Bench Approach

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