Combination of A2DS2 score, procalcitonin and C-reactive protein predicts stroke-associated pneumonia in patients with acute ischemic stroke

Abstract

Objective To investigate the value of combination of A2DS2 score, procalcitonin (PCT) and C-reactive protein (CRP) predicting stroke-associated pneumonia (SAP) in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke admitted to the Department of Neurology, Suqian People's Hospital of Nanjing Drum Tower Hospital Group from March 2015 to March 2019 were enrolled retrospectively. Multivariate logistic regression analysis was used to determine the independent correlation of A2DS2 scores as well as PCT and CRP levels with SAP. Receiver operating characteristic (ROC) curves were used to assess the individual and combined predictive values of A2DS2 scores, PCT and CRP levels for SAP. Results A total of 332 patients with acute ischemic stroke were enrolled, and 58 of them developed SAP (17.5%). After adjusting for age, smoking, and hyperlipidemia, the A2DS2 score (odds ratio [OR] 1.613, 95% confidence interval [CI] 1.092-2.389), PCT (OR 8.047, 95% CI 3.012-16.138) and CRP (OR 1.409, 95% CI 1.064-2.672) were the independent predictors of SAP occurrence. ROC curve analysis showed that the area under the curve of A2DS2 score, PCT and CRP alone, and the combination of the three for predicting SAP were 0.811, 0.825, 0.804 and 0.910, respectively. When the three are jointly used to predict SAP, the area under the curve is significantly higher than the individual prediction (all P<0.001). Conclusions The combination of A2DS2 score, PCT and CRP can improve the ability to predict SAP. Key words: Stroke; Brain ischemia; Pneumonia; C-Reactive protein; Procalcitonin; Risk assessment; Predictive value of tests