Background
Stroke-associated pneumonia often negatively influences the prognosis of stroke patients.
The aims of this study were to determine the frequency of pneumonia and to investigate
the correlation between pneumonia and prognosis in stroke patients receiving intravenous
thrombolysis with recombinant tissue plasminogen activator (IV thrombolysis).
Methods
Between 2008 and 2013, 538 consecutive stroke patients (mean age, 72 ± 13 years; 50.4%
women) receiving IV thrombolysis at the Department of Neurology, University of Lübeck,
were investigated.
Results
Pneumonia occurred among 122 patients (23%; 95% confidence interval [CI], 19.1-26.2).
Pneumonia patients were older (76 versus 71 years; P < .001), more severely affected at admission (National Institutes of Health Stroke
Scale [NIHSS] score, 13 versus 9; P < .001), and more likely to have atrial fibrillation (54% versus 42%; P = .02) than patients without pneumonia. They had also a longer hospitalization (15
versus 10 days; P < .001). Using logistic regression analysis, the occurrence of pneumonia was associated
with male sex (odds ratio [OR], 1.9; 95% CI, 1.2-3.1; P = .006), neurologic deficit severity (NIHSS score ≥10; OR, 4.4; 95% CI, 2.5-7.4;
P < .0019), previous stroke (OR, 1.5; 95% CI, 1.0-2.2; P = .06), and occurrence of symptomatic intracerebral hemorrhage (OR, 1.6; 95% CI,
1.0-3.2; P = .048). Mortality rates (in-hospital mortality [18.9% versus 7.0; P < .0019]; 3-month mortality [34.3% versus 10.6%; P < .001], and 12-month mortality [53.6% versus 19.6%; P < .001]) were higher in pneumonia patients than those without. A favorable outcome
(modified Rankin Scale score ≤2) was more likely in patients without pneumonia than
those with pneumonia (42% versus 7%; P < .001).
Conclusion
Pneumonia was correlated with increased age, male sex, neurologic deficit severity,
and a less favorable prognosis.
Key Words
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References
- Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.Lancet. 2004; 363: 768-774
- Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers Study Group.Arch Intern Med. 2004; 164: 1761-1768
- Central nervous system injury-induced immune deficiency syndrome.Nat Rev Neurosci. 2005; 6: 775-786
- Novel preventive and therapeutic strategy for post-stroke pneumonia.Expert Rev Neurother. 2009; 9: 1187-1200
- Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke: data from the Netherlands Stroke Survey.Cerebrovasc Dis. 2009; 27: 465-471
- Stroke-associated pneumonia: major advances and obstacles.Cerebrovasc Dis. 2013; 35: 430-443
- Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients.Dysphagia. 2001; 16: 1-6
- Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit.J Neurol. 2007; 254: 1323-1329
- Post-stroke infection: a systematic review and meta-analysis.BMC Neurol. 2011; 11: 110
- Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit.Neurology. 2011; 77: 965-972
- Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept.J Neurol. 2010; 257: 1492-1499
- Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine.Stroke. 2003; 34: 975-981
- Training in swallowing prevents aspiration pneumonia in stroke patients with dysphagia.J Int Med Res. 2006; 34: 303-306
- Utility of dysphagia screening results in predicting poststroke pneumonia.Stroke. 2010; 41: 2849-2854
- The immunology of acute stroke.Nat Rev Neurol. 2012; 8: 401-410
- Stroke-induced immunodepression: Experimental evidence and clinical relevance.Stroke. 2007; 38: 770-773
- Stroke propagates bacterial aspiration to pneumonia in a model of cerebral ischemia.Stroke. 2006; 37: 2607-2612
- Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial.PLoS One. 2008; 3: 2158
- Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II).Lancet. 1998; 352: 1245-1251
- Reduced risk of poststroke pneumonia in thrombolyzed stroke patients with continued statin treatment.Int J Stroke. 2015; 10 (Epub September 13, 2012): 61-66
- Complications following acute ischemic stroke.Eur Neurol. 2002; 48: 133-140
- The interaction of aspiration pneumonia with demographic and cerebrovascular disease risk factors is predictive of discharge level of care in acute stroke patient.Am J Phys Med Rehabil. 2012; 91: 141-147
- The impact of lesion location and lesion size on poststroke infection frequency.J Neurol Neurosurg Psychiatry. 2010; 81: 198-202
- Risk factors for chest infection in acute stroke: a prospective cohort study.Stroke. 2007; 38: 2284-2291
- Application of A(2)DS(2) score for predicting post-stroke pneumonia in elderly patients.J South Med Univ. 2013; 33: 1615-1619
- Increased rate of aspiration pneumonia and poor discharge outcome among acute ischemic stroke patients following intubation for endovascular treatment.Neurocrit Care. 2012; 16: 246-250
- Risk factors for early infection after an acute cerebral infarction.J Med Assoc Thai. 2005; 88: 150-155
- Poststroke infections are an independent risk factor for poor functional outcome after three-months in thrombolysed stroke patients.Int J Stroke. 2013; 8: 639-644
- Predictors of in-hospital mortality and the risk of symptomatic intracerebral hemorrhage after thrombolytic therapy with recombinant tissue plasminogen activator in acute ischemic stroke.J Stroke Cerebrovasc Dis. 2014; 23: 7-11
- The pneumonia score: a simple grading scale for prediction of pneumonia after acute stroke.Am J Infect Control. 2006; 34: 64-68
- Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial.Eur J Neurol. 2004; 11: 49-53
- Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit.J Neurol Sci. 2011; 306: 38-41
- Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen.Stroke. 2007; 38: 2948-2952
- Effects of prophylactic antibiotic therapy with mezlocillin plus sulbactam on the incidence and height of fever after severe acute ischemic stroke: the Mannheim infection in stroke study (MISS).Stroke. 2008; 39: 1220-1227
- The early systemic prophylaxis of infection after stroke study: a randomized clinical trial.Stroke. 2005; 36: 1495-1500
Article info
Publication history
Published online: June 04, 2015
Accepted:
March 15,
2015
Received in revised form:
November 22,
2014
Received:
July 1,
2014
Footnotes
The authors declare that they have no conflicts of interest in the research.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.045
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
