Eady risk factors for pneunmnia in acute stroke patients with dysphagia： a prospective case series study

Abstract

Objective To investigate the early risk factors for stroke-associated pneumonia （SAP） in acute stroke patients with dysphagia. Methods The modified Mann assessment of swallowing ability （MMASA） was used to screen dysphagia in patients with acute stroke admitted to hospital within 24 hours after symptom onset. The patients with dysphagia were used as research subjects. They were divided into either a SAP goup or a non-SAP group according to whether they had SAP or not within one week of symptom onset. Univariate and multivariate logistic regression analyses were used to analyze the data of demogaphy, past history, clinical practice, and laboratory. The early risk factors for the occurrence of SAP in patients with dysphagia were identified. The independent risk factors were analyzed with receiver operating characteristic （ROC） curves in order to assess their predictive value for SAP. Results Of the 113 patients with acute stroke, 55 had dysphagia, and 30 of them （54. 54% ） had SAP. Univariate analysis showed that the National Institutes of Health Stroke Scale （NIHSS） score （median, [ interquartile range] 16, [13 -21 ] vs. 3, [ 1 -7 ] ; P = 0. 000）, nentrophil counts （[ 8.22 ± 3.75 ] × 10^9/L vs. [ 5. 39 ± 2. 56] × 10^9/L; t = 3. 198; P = 0. 002, proportion of hemorrhagic stroke （96. 00% vs. 4. 00% ; X^2 = 7. 333; P = 0. 007, and proportion of mechanical ventilation （20.00% vs. 0.00%; X^2 = 5.612; P= 0.018 in the SAP group （n= 30） were sigantly higher than those in the non-SAp group （n =25）, while the MMASA score （median, E interquartile range] 53, [ 27 - 84 ] vs. 88, [ 66 - 92 ] ; P = 0. 002）, Glasgow Coma sCale （GCS） score （median, [ interquartile range] 10, [7 - 13] vs. 15, [ 11 - 15] ; P =0. 001）, lymphocyte counts （[ 1. 17 ±0. 54] × 10^9/L vs. [ 1.75 ± 0. 81 ] 10^9/L; t = - 3. 563, P = 0. 001, CD3 ^＋ T lymphocyte counts （[0.73 ± 0. 42] × 10^9/L vs. [ 1. 14 ~ 0.85] × 10^9/L; t= -2.307; P= 0.025, and CD4^＋T lymphocyte counts （[0.38± 0.22]× 10^9/L vs. [0. 69 s0. 57] × 10^9/L; t = -2. 761; P=0. 008 were significantly lower than those in the non-SAP group. Multivariate logistic reffession analysis showed that the NIHSS score was higher at admission （odds ratio [ OR ], 1.206,95% confidence interval [ CI ] 1.076- 1.351; P=0.001） and the CD4^＋T lymphocyte counts decreased （ OR, 0. 974,95% CIO. 952 -0. 997; P =0. 025） were the independent risk factors for SAP in stroke patients with dysphagia. The NIHSS score ≥ 10. 5 had good predictive value for SAP, and its sensitivity and specificity were 86. 7% and 72. 0% respectively （P =0. 000）. Conclusions More than half of the acute stroke patients with dysphagia occurred SAP. The NIHSS score at admission, neutrophil counts, stroke types, mechanical ventilation, MMASA score, GCS score, lymphocyte counts, CD3 ^＋T lymphocyte counts, CD4^＋T lymphocyte counts, and other factors were associated with occurrence of SAP in patients with dysphagia, in which a higher NIHSS score and a decreased CD4＋T lymphocyte counts were independent risk factors for the occurrence of SAP in stroke patients with dysphagia. The NIHSS score ≥ 10. 5 at admission had higher predictive value. Key words: Stroke; Degtutition Disorders; Pneumonia; Risk Factors