Abstract
BackgroundStroke-associated pneumonia (SAP) is common in patients with acute ischemic stroke, and several risk factors have been reported. However, the relationship between underlying leukoaraiosis (LA) and SAP has not been addressed.MethodsWe collected consecutive patients with acute ischemic stroke within 24 h of symptom onset. SAP was defined as the lower respiratory tract infection within the first 7 days after stroke onset, according to the modified Centers for Disease Control and Prevention criteria. LA was graded using the Fazekas scale in both the periventricular and subcortical areas. We evaluated LA burden by summing the grade and dichotomized into mild LA (0–2) or severe LA (3–6). Relationship between LA and SAP was analyzed by binary logistic regression analysis with variables of P < 0.05 in univariate analysis.ResultsThree hundred eight consecutive patients were enrolled, and SAP developed in 44 patients (14%). Univariate analysis revealed that SAP correlated with age, initial NIHSS score, atrial fibrillation, impaired consciousness, dysphagia, severe LA and hyperlipidemia. On multivariate analysis, severe LA [adjusted OR (aOR) = 4.41, 95% CI = 2.04–9.55, P < 0.001 remained independent predictors of SAP after adjusted confounders.ConclusionsIn this study, LA was an independent predictor of SAP. This observation needs to be confirmed in suitably-designed, prospective studies.
Highlights
Stroke-associated pneumonia (SAP) is common in patients with acute ischemic stroke, and several risk factors have been reported
Atrial fibrillation, impaired consciousness, dysphagia and severe LA were more frequent in the SAP group, while hyperlipidemia was less
SAP stroke-associated pneumonia, NIHSS National Institute of Health Stroke Scale, hs-CRP high-sensitivity C-reactive protein and high A2 DS2 score remained independent predictors of SAP (Table 2)
Summary
Stroke-associated pneumonia (SAP) is common in patients with acute ischemic stroke, and several risk factors have been reported. The relationship between underlying leukoaraiosis (LA) and SAP has not been addressed. Pneumonia is a common and significant complication in patients with acute ischemic stroke. The incidence of pneumonia in patients with acute ischemic stroke ranges from 5 to 26% [1, 2]. Stroke-associated pneumonia (SAP) is correlated with poor functional outcome, prolonged hospitalization and high mortality (up to 6-fold) [2, 3]. Rapid assessment of high-risk patients is thought to be needed. Leukoaraiosis (LA) is a hyperintense lesion seen in the cerebral white matter of T2-weighted magnetic resonance Known predictors of SAP include dysphagia, age, male sex, initial stroke severity, nonlacunar stroke type, diabetes, consciousness, atrial fibrillation and acid-suppressive drugs [1, 2, 4, 5].
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