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Abstract

Introduction: Stroke patients are susceptible to many complications. Several complications can arise as a direct consequence of hospital acquired pneumonia (HAP) and have an important effect on the final neurological recovery. Mechanical ventilation (MV), length of stay (LOS), and in-hospital mortality (mort) are among complications that can be adversely impacted by HAP. Methods: We conducted a retrospective cohort study among adults with a primary diagnosis of stroke (2007-2011). HAP was defined as a clinical diagnosis of pneumonia 48 hours post admission requiring treatment with antibiotics. Patient characteristics like stroke type, NIHSS score, comorbidities were recorded in addition to complications like acute kidney injury (AKI), Clostridium Difficile (cdif), congestive heart failure (CHF), myocardial infarction (MI), sepsis, deep vein thrombosis (DVT), Urinary tract infection (UTI) and dysphagia. We measured LOS, MV and mort. Results: Of 443 patients hospitalized with stroke, 74 (17%) developed HAP. Among those, 10% had only HAP, 34% had 1-2 additional complications, 34% had 3-4 complications and 22% had >5 complications. Patients with HAP had increased complications compared to patients without HAP. Respiratory failure (61% vs. 7%), Dysphagia (37% vs. 16%), AKI (26% vs. 7%), UTI (23% vs.12%), Sepsis (22% vs. 3%), Myocardial infarction (18% vs. 5%), DVT (14% vs. 5%) and cdif (12% vs. 0.3%) were all significantly higher in patients who developed HAP. LOS >2 weeks (82% vs. 18%), MV >7 days (77% vs. 29%) and mort (30% vs. 17%) were statistically significant in the cohort that developed HAP. Conclusions: Among stroke patients that develop HAP, 56% develop ≥ 3 additional complications due to HAP. Development of HAP post stroke is associated with increased LOS (82 % >15 days), MV (77 % > 7 days) and a 1.8 fold increase in hospital mortality. This significantly effects morbidity, delayed neurological recovery, in-hospital mortality and increased health care utilization costs. More research needs to be focused on the early prevention, diagnosis and treatment of HAP and its associated complications in patients post stroke.