Study of the risk factors for stroke-associated pneumonia_West China Medical Journal

Authors：

HE Yuting ^1,2 ,  WU Bo ¹

1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Neurology, the Sixth People’s Hospital of Chengdu, Chengdu, Sichuan 610051, P. R. China;

Corresponding author：

WU Bo, Email: dr.bowu@hotmail.com

Keywords：

Acute ischemic stroke; Stroke-associated pneumonia; Risk factors

DOI：

10.7507/1002-0179.202010025

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.Methods From November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.Results A total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.Conclusions Age≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.

Citation： HE Yuting, WU Bo. Study of the risk factors for stroke-associated pneumonia. West China Medical Journal, 2021, 36(5): 638-642. doi: 10.7507/1002-0179.202010025 Copy

1.	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2014. 中华神经科杂志, 2015, 48(4): 246-257.
2.	Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke, 2003, 34(4): 975-981.
3.	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.
4.	Hannawi Y, Hannawi B, Rao CP, et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis, 2013, 35(5): 430-443.
5.	Ovbiagele B, Hills NK, Saver JL, et al. Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization. J Stroke Cerebrovasc Dis, 2006, 15(5): 209-213.
6.	Lakshminarayan K, Tsai AW, Tong X, et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke, 2010, 41(12): 2849-2854.
7.	Katzan IL, Dawson NV, Thomas CL, et al. The cost of pneumonia after acute stroke. Neurology, 2007, 68(22): 1938-1943.
8.	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.
9.	Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis, 2012, 21(1): 61-67.
10.	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.
11.	Sui R, Zhang L. Risk factors of stroke-associated pneumonia in Chinese patients. Neurol Res, 2011, 33(5): 508-513.
12.	高小荣, 高玉堂, 项永兵. 上海市区慢性肺部疾病史与男性肺癌关系的前瞻性队列研究. 肿瘤, 2010, 30(6): 500-504.
13.	刘力生. 中国高血压防治指南2010. 中华高血压杂志, 2011, 19(8): 701-743.
14.	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2010年版). 中国糖尿病杂志, 2012, 20(1): 81-117.
15.	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 慢性心力衰竭诊断治疗指南. 中华心血管病杂志, 2007, 35(12): 1076-1095.
16.	陈璇, 区嘉欢, 蔡贤斌. GCS和FOUR量表对意识障碍程度及预后评价的比较. 实用医学杂志, 2013, 29(13): 2152-2154.
17.	黄立安, 黄舜韶, 蒋亚宾. 球麻痹的诊断与治疗. 现代临床医学生物工程学杂志, 2000, 6(2): 56-56.
18.	Liu DD, Chu SF, Chen C, et al. Research progress in stroke-induced immunodepression syndrome (SIDS) and stroke-associated pneumonia(SAP). Neurochem Int, 2018, 114: 42-54.
19.	王拥军, 陈玉国, 吕传柱, 等. 卒中相关性肺炎诊治中国专家共识(2019更新版). 中国卒中杂志, 2019, 14(12): 1251-1262.
20.	Chamorro Á, Meisel A, Planas AM, et al. The immunology of acute stroke. Nat Rev Neurol, 2012, 8(7): 401-410.
21.	Ji R, Shen H, Pan Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke, 2013, 44(5): 1303-1309.
22.	Fromm A, Waje-Andreassen U, Thomassen L, et al. Comparison between ischemic stroke patients <50 years and ≥50 years admitted to a single centre: the bergen stroke study. Stroke Res Treat, 2011, 2011: 183256.
23.	Birjandi S, Witte P. Why are the elderly so susceptible to pneumonia?. Expert Rev Respir Med, 2011, 5(5): 593-595.
24.	Zhang X, Yu S, Wei L, et al. The A2DS2 score as a predictor of pneumonia and in-hospital death after acute ischemic stroke in Chinese populations. PLoS One, 2016, 11(3): e0150298.
25.	Sellars C, Bowie L, Bagg J, et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke, 2007, 38(8): 2284-2291.
26.	Quyet D, Hien NM, Khan MX, et al. Risk factors for stroke associated pneumonia. Open Access Maced J Med Sci, 2019, 7(24): 4416-4419.
27.	Yeh SJ, Huang KY, Wang TG, et al. Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit. J Neurol Sci, 2011, 306(1/2): 38-41.
28.	Mahoney C, Rowat A, Macmillan M, et al. Nasogastric feeding for stroke patients: practice and education. Br J Nurs, 2015, 24(6): 319-325.
29.	刘瑞华, 王荔. 卒中相关性肺炎的危险因素分析及病原学特点. 临床神经病学杂志, 2014, 27(1): 53-55.
30.	Bray BD, Smith CJ, Cloud GC, et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry, 2017, 88(1): 25-30.
31.	Chapman C, Morgan P, Cadilhac DA, et al. Risk factors for the development of chest infections in acute stroke: a systematic review. Top Stroke Rehabil, 2018, 25(6): 445-458.
32.	Ntoumenopoulos G, Presneill JJ, McElholum M, et al. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med, 2002, 28(7): 850-856.
33.	Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med, 2000, 247(1): 39-42.
34.	Dziewas R, Ritter M, Schilling M, et al. Pneumonia in acute stroke patients fed by nasogastric tube. J Neurol Neurosurg Psychiatry, 2004, 75(6): 852-856.
35.	Gomes GF, Pisani JC, Macedo ED, et al. The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia. Curr Opin Clin Nutr Metab Care, 2003, 6(3): 327-333.

1. 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2014. 中华神经科杂志, 2015, 48(4): 246-257.
2. Hilker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke, 2003, 34(4): 975-981.
3. 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.
4. Hannawi Y, Hannawi B, Rao CP, et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis, 2013, 35(5): 430-443.
5. Ovbiagele B, Hills NK, Saver JL, et al. Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization. J Stroke Cerebrovasc Dis, 2006, 15(5): 209-213.
6. Lakshminarayan K, Tsai AW, Tong X, et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke, 2010, 41(12): 2849-2854.
7. Katzan IL, Dawson NV, Thomas CL, et al. The cost of pneumonia after acute stroke. Neurology, 2007, 68(22): 1938-1943.
8. 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.
9. Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis, 2012, 21(1): 61-67.
10. 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.
11. Sui R, Zhang L. Risk factors of stroke-associated pneumonia in Chinese patients. Neurol Res, 2011, 33(5): 508-513.
12. 高小荣, 高玉堂, 项永兵. 上海市区慢性肺部疾病史与男性肺癌关系的前瞻性队列研究. 肿瘤, 2010, 30(6): 500-504.
13. 刘力生. 中国高血压防治指南2010. 中华高血压杂志, 2011, 19(8): 701-743.
14. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2010年版). 中国糖尿病杂志, 2012, 20(1): 81-117.
15. 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 慢性心力衰竭诊断治疗指南. 中华心血管病杂志, 2007, 35(12): 1076-1095.
16. 陈璇, 区嘉欢, 蔡贤斌. GCS和FOUR量表对意识障碍程度及预后评价的比较. 实用医学杂志, 2013, 29(13): 2152-2154.
17. 黄立安, 黄舜韶, 蒋亚宾. 球麻痹的诊断与治疗. 现代临床医学生物工程学杂志, 2000, 6(2): 56-56.
18. Liu DD, Chu SF, Chen C, et al. Research progress in stroke-induced immunodepression syndrome (SIDS) and stroke-associated pneumonia(SAP). Neurochem Int, 2018, 114: 42-54.
19. 王拥军, 陈玉国, 吕传柱, 等. 卒中相关性肺炎诊治中国专家共识(2019更新版). 中国卒中杂志, 2019, 14(12): 1251-1262.
20. Chamorro Á, Meisel A, Planas AM, et al. The immunology of acute stroke. Nat Rev Neurol, 2012, 8(7): 401-410.
21. Ji R, Shen H, Pan Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke, 2013, 44(5): 1303-1309.
22. Fromm A, Waje-Andreassen U, Thomassen L, et al. Comparison between ischemic stroke patients <50 years and ≥50 years admitted to a single centre: the bergen stroke study. Stroke Res Treat, 2011, 2011: 183256.
23. Birjandi S, Witte P. Why are the elderly so susceptible to pneumonia?. Expert Rev Respir Med, 2011, 5(5): 593-595.
24. Zhang X, Yu S, Wei L, et al. The A2DS2 score as a predictor of pneumonia and in-hospital death after acute ischemic stroke in Chinese populations. PLoS One, 2016, 11(3): e0150298.
25. Sellars C, Bowie L, Bagg J, et al. Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke, 2007, 38(8): 2284-2291.
26. Quyet D, Hien NM, Khan MX, et al. Risk factors for stroke associated pneumonia. Open Access Maced J Med Sci, 2019, 7(24): 4416-4419.
27. Yeh SJ, Huang KY, Wang TG, et al. Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit. J Neurol Sci, 2011, 306(1/2): 38-41.
28. Mahoney C, Rowat A, Macmillan M, et al. Nasogastric feeding for stroke patients: practice and education. Br J Nurs, 2015, 24(6): 319-325.
29. 刘瑞华, 王荔. 卒中相关性肺炎的危险因素分析及病原学特点. 临床神经病学杂志, 2014, 27(1): 53-55.
30. Bray BD, Smith CJ, Cloud GC, et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry, 2017, 88(1): 25-30.
31. Chapman C, Morgan P, Cadilhac DA, et al. Risk factors for the development of chest infections in acute stroke: a systematic review. Top Stroke Rehabil, 2018, 25(6): 445-458.
32. Ntoumenopoulos G, Presneill JJ, McElholum M, et al. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Med, 2002, 28(7): 850-856.
33. Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med, 2000, 247(1): 39-42.
34. Dziewas R, Ritter M, Schilling M, et al. Pneumonia in acute stroke patients fed by nasogastric tube. J Neurol Neurosurg Psychiatry, 2004, 75(6): 852-856.
35. Gomes GF, Pisani JC, Macedo ED, et al. The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia. Curr Opin Clin Nutr Metab Care, 2003, 6(3): 327-333.

West China Medical Journal

Study of the risk factors for stroke-associated pneumonia

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content