A2DS2 score predicts stroke-associated pneumonia in patients with anterior and posterior circulation ischemic stroke

Abstract

Objective To investigate the value of A2DS2 score in predicting stroke-associated pneumonia (SAP) in patients with anterior and posterior circulation ischemic stroke. Methods The clinical data of patients with acute ischemic stroke admitted to the Department of Neurology, Heze Municipal Hospital from June 2011 to March 2016 were analyzed retrospectively. The independent risk factors for SAP were determined by binary multivariate logistic regression analysis. The value of A2DS2 score in predicting SAP in patients with anterior and posterior circulation ischemic stroke was evaluated by the receiver operator characteristic (ROC) curve. Results A total of 530 patients with acute ischemic stroke were enrolled, 90 of them (16.98%) had SAP. There was no significant difference in SAP incidence between the patients with anterior circulation stroke (n=430) and posterior circulation stroke (n=100) (17.2% vs. 16.0%; χ2=0.084, P=0.772). Binary multivariate logistic regression analysis showed that the A2DS2 score was an independent risk factor for SAP in patients with ischemic stroke (odds ratio [OR] 1.644, 95% confidence interval [CI] 1.097-2.426), anterior circulation stroke (OR 1.593, 95% CI 1.086-2.387), and posterior circulation stroke (OR 1.463, 95% CI 1.064-2.174). The ROC curve showed that the area under the curve of the A2DS2 score predicting SAP in patients with ischemic stroke, anterior circulation and posterior circulation stroke were 0.826 (95% CI 0.792-0.869), 0.821 (95% CI 0.783-0.858), and 0.832 (95% CI 0.781-0.923), respectively. The best cut-off value was 5. There was no significant difference in the area under SAP curve of the A2DS2 score for predicting SAP between patients with acute anterior circulation and posterior circulation ischemic stroke (Z=0.259, P=0.394). Conclusion A2DS2 score could predict SAP in patients with anterior circulation and posterior circulation stroke without difference, both of the cut-off value was 5. Key words: Stroke; Brain ischemia; Pneumonia; Risk assessment; Predictive value of tests; Risk factors