Risk factors of stroke-associated pneumonia in stroke inpatients at rehabilitation stage_West China Medical Journal

Authors：

WANG Yuyuan ¹ , ZHAO Juan ¹ ,  BAI Yulong ²

1. Department of Rehabilitation Medicine, Huashan Hospital North, Fudan University, Shanghai 201907, P. R. China;
2. Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P. R. China;

Corresponding author：

BAI Yulong, Email: dr_baiyl@fudan.edu.cn

Keywords：

Stroke-associated pneumonia; Risk factor; Stroke; Rehabilitation

DOI：

10.7507/1002-0179.201903232

Video：

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Objective To explore the risk factors of stroke-associated pneumonia in stroke inpatients at rehabilitation stage.Methods A retrospective survey was conducted to collect the general clinical data of 271 patients with stroke who were hospitalized for the first time between January 2017 and December 2018. They were divided into two groups according to the presence or absence of pneumonia. The general clinical data of the two groups were observed and analyzed, including sex, age, length of stay, course of disease, Brunnstrom Stage, Barthel Index, scores of Kubota’s Water Drinking Test, indwelling gastric tube, cognitive impairment, aphasia, hypertension history, diabetes history, history of smoking and drinking, albumin content, and hemoglobin content. Statistically significant factors were screened out from single factor analysis, and then multivariate logistic regression analysis was conducted.Results There were significant differences in age, length of stay, Barthel Index, Brunnstrom Stage (upper limb, hand and lower limb), scores of Kubota’s Water Drinking Test, indwelling gastric tube, albumin content, hemoglobin content, cognitive impairment, and aphasia between the two groups (P<0.05). Multivariate logistic regression analysis showed that indwelling gastric tube [odds ratio=52.463, 95% confidence interval (4.154, 662.658), P=0.002] was an independent risk factor for pneumonia.Conclusions Indwelling gastric tube is an independent risk factor for pneumonia. In view of the risk factor, taking active and effective preventive measures can help prevent pneumonia.

Citation： WANG Yuyuan, ZHAO Juan, BAI Yulong. Risk factors of stroke-associated pneumonia in stroke inpatients at rehabilitation stage. West China Medical Journal, 2019, 34(5): 509-514. doi: 10.7507/1002-0179.201903232 Copy

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5.	Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand, 2018, 138(4): 293-300.
6.	Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis, 2012, 21(1): 61-67.
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11.	Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke, 2005, 36(12): 2756-2763.
12.	Abubakar S, Jamoh BY. Dysphagia following acute stroke and its effect on short-term outcome. Niger Postgrad Med J, 2017, 24(3): 182-186.
13.	Arnold M, Liesirova K, Broeg-Morvay AA, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS One, 2016, 11(2): e0148424.
14.	Smithard DG, Smeeton NC, Wolfe CD. Long-term outcome after stroke: does dysphagia matter? . Age Ageing, 2007, 36(1): 90-94.
15.	Xu ZQ, Gu YQ, Li JX, et al. Dysphagia and aspiration pneumonia in elderly hospitalization stroke patients: risk factors, cerebral infarction area comparison. J Back Musculoskelet Rehabil, 2019, 32(1): 85-91.
16.	Perry L, Hamilton S, Williams J, et al. Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes. Worldviews Evid Based Nurs, 2013, 10(1): 17-40.
17.	Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J, 2006, 82(968): 383-391.
18.	Singer P, Anbar R, Cohen J, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med, 2011, 37(4): 601-609.
19.	Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke, 2016, 47(6): e98-e169.
20.	Katzan IL, Cebul RD, Husak SH, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology, 2003, 60(4): 620-625.
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22.	Matz K, Seyfang L, Dachenhausen AA, et al. Post-stroke pneumonia at the stroke unit a registry based analysis of contributing and protective factors. BMC Neurol, 2016, 16(1): 107.
23.	De Wit L, Putman K, Devos H, et al. Long-term prediction of functional outcome after stroke using single items of the Barthel Index at discharge from rehabilitation centre. Disabil Rehabil, 2014, 36(5): 353-358.
24.	Chamorro A, Urra X, Planas AM. Infection after acute ischemic stroke: a manifestation of brain-induced immunodepression. Stroke, 2007, 38(3): 1097-1103.
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26.	Dirnagl U, Klehmet J, Braun JS, et al. Stroke-induced immunodepression: experimental evidence and clinical relevance. Stroke, 2007, 38(2): 770-773.
27.	Lin YM, Wang M, Sun NX, et al. Screening and application of nutritional support in elderly hospitalized patients of a tertiary care hospital in China. PLoS One, 2019, 14(3): e0213076.
28.	Garcia Rodriguez LA, Ruigomez A, Wallander MA, et al. Acid-suppressive drugs and community-acquired pneumonia. Epidemiology, 2009, 20(6): 800-806.
29.	Eom CS, Jeon CY, Lim JW, et al. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ, 2011, 183(3): 310-319.
30.	Herzig SJ, Doughty C, Lahoti S, et al. Acid-suppressive medication use in acute stroke and hospital-acquired pneumonia. Ann Neurol, 2014, 76(5): 712-718.

1. Hung JW, Tsay TH, Chang HW, et al. Incidence and risk factors of medical complications during inpatient stroke rehabilitation. Chang Gung Med J, 2005, 28(1): 31-38.
2. Roth EJ, Lovell L, Harvey RL, et al. Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke, 2001, 32(2): 523-529.
3. Chen CM, Hsu HC, Chang CH, et al. Age-based prediction of incidence of complications during inpatient stroke rehabilitation: a retrospective longitudinal cohort study. BMC Geriatr, 2014, 14(1): 41.
4. Badve MS, Zhou Z, van de Beek D, et al. Frequency of post-stroke pneumonia: systematic review and meta-analysis of observational studies. Int J Stroke, 2019, 14(2): 125-136.
5. Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand, 2018, 138(4): 293-300.
6. Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis, 2012, 21(1): 61-67.
7. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018. 中华神经科杂志, 2018, 51(9): 666-682.
8. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014). 中华神经科杂志, 2015, 48(6): 435-444.
9. 卒中相关性肺炎诊治中国专家共识组. 卒中相关性肺炎诊治中国专家共识. 中华内科杂志, 2010, 49(12): 1075-1078.
10. Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neuro1ogical intensive care medicine. Stroke, 2003, 34(4): 975-981.
11. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke, 2005, 36(12): 2756-2763.
12. Abubakar S, Jamoh BY. Dysphagia following acute stroke and its effect on short-term outcome. Niger Postgrad Med J, 2017, 24(3): 182-186.
13. Arnold M, Liesirova K, Broeg-Morvay AA, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS One, 2016, 11(2): e0148424.
14. Smithard DG, Smeeton NC, Wolfe CD. Long-term outcome after stroke: does dysphagia matter? . Age Ageing, 2007, 36(1): 90-94.
15. Xu ZQ, Gu YQ, Li JX, et al. Dysphagia and aspiration pneumonia in elderly hospitalization stroke patients: risk factors, cerebral infarction area comparison. J Back Musculoskelet Rehabil, 2019, 32(1): 85-91.
16. Perry L, Hamilton S, Williams J, et al. Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes. Worldviews Evid Based Nurs, 2013, 10(1): 17-40.
17. Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad Med J, 2006, 82(968): 383-391.
18. Singer P, Anbar R, Cohen J, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med, 2011, 37(4): 601-609.
19. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke, 2016, 47(6): e98-e169.
20. Katzan IL, Cebul RD, Husak SH, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology, 2003, 60(4): 620-625.
21. Teramoto S. Novel preventive and therapuetic strategy for post-stroke pneumonia. Expert Rev Neurother, 2009, 9(8): 1187-1200.
22. Matz K, Seyfang L, Dachenhausen AA, et al. Post-stroke pneumonia at the stroke unit a registry based analysis of contributing and protective factors. BMC Neurol, 2016, 16(1): 107.
23. De Wit L, Putman K, Devos H, et al. Long-term prediction of functional outcome after stroke using single items of the Barthel Index at discharge from rehabilitation centre. Disabil Rehabil, 2014, 36(5): 353-358.
24. Chamorro A, Urra X, Planas AM. Infection after acute ischemic stroke: a manifestation of brain-induced immunodepression. Stroke, 2007, 38(3): 1097-1103.
25. Meisel C, Schwab JM, Prass K, et al. Central nervous system injury-induced immune deficiency syndrome. Nat Rev Neurosci, 2005, 6(10): 775-786.
26. Dirnagl U, Klehmet J, Braun JS, et al. Stroke-induced immunodepression: experimental evidence and clinical relevance. Stroke, 2007, 38(2): 770-773.
27. Lin YM, Wang M, Sun NX, et al. Screening and application of nutritional support in elderly hospitalized patients of a tertiary care hospital in China. PLoS One, 2019, 14(3): e0213076.
28. Garcia Rodriguez LA, Ruigomez A, Wallander MA, et al. Acid-suppressive drugs and community-acquired pneumonia. Epidemiology, 2009, 20(6): 800-806.
29. Eom CS, Jeon CY, Lim JW, et al. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ, 2011, 183(3): 310-319.
30. Herzig SJ, Doughty C, Lahoti S, et al. Acid-suppressive medication use in acute stroke and hospital-acquired pneumonia. Ann Neurol, 2014, 76(5): 712-718.

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