Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit |
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Authors: | Uwe Walter Rupert Knoblich Volker Steinhagen Martina Donat Reiner Benecke Antje Kloth |
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Institution: | (1) Dept. of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany;(2) Dept. of Medical Microbiology & Hospital Hygiene, University of Rostock, Rostock, Germany;(3) Geriatric Rehabilitation Hospital, Tessin, Germany |
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Abstract: | Abstract
Objective
To determine independent clinical predictors of stroke-associated pneumonia (SAP) that are available in all patients on day
of hospital admission.
Methods
We studied 236 patients with acute ischemic stroke admitted to the neurological intensive care unit at our university hospital.
Risk factors of SAP and of non-responsivity of early-onset pneumonia (EOP; onset within 72 hours after admission) to initial
antibacterial treatment were analyzed.
Results
Incidence of SAP was 22%. The following independent risk factors were found to predict SAP with 76% (EOP: 90%) sensitivity
and 88% specificity: dysphagia (RR, 9.92; 95% CI, 5.28-18.7), National Institute of Health Stroke Scale ≥ 10 (RR, 6.57; CI,
3.36-12.9), non-lacunar basal-ganglia infarction (RR, 3.10; CI, 1.17-5.62), and any other infection present on admission (RR,
3.78; CI, 2.45-5.83). Excluding the patients with other infections on admission, the same independent risk factors (except
infection) were found. Further, but not independent risk factors were: combined brainstem and cerebellar infarction, infarction
affecting more than 66% of middle cerebral artery territory, hemispheric infarction exceeding middle cerebral artery territory,
impaired vigilance, mechanical ventilation, age ≥ 73 years, current malignoma, and cardioembolic stroke, whereas patients
with lacunar infarctions had significantly lower risk. In contrast to previous reports, no impact of male gender or diabetes
was found. Initial vomiting, especially if associated with impaired vigilance, predicted antibacterial treatment non-responsivity
of EOP. In nonresponders exclusively fungal pathogens were identified.
Conclusion
Increased risk of pneumonia in acute stroke patients can be sufficiently predicted by a small set of clinical risk factors. |
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Keywords: | pneumonia dysphagia basal ganglia ischemic stroke stroke-induced immunosuppression |
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