Pneumonia in patients with stroke: risk factors, identification of at-risk patients, and methods of prevention

Abstract

Stroke-associated pneumonia (SAP) is the most common complication of the early stage of ischaemic stroke. The prevalence of SAP is difficult to determine precisely, but it is estimated to affect 2–22% of patients in the acute phase of stroke. Strokeassociated pneumonia is a clinically significant problem, as it markedly increases the risk of death compared to the population of acute stroke patients without pneumonia. In addition, SAP is associated with poorer final functional status, greater dependence on other people’s help after hospital discharge, extended hospital stay, and higher treatment costs. The paper presents the risk factors for stroke-related pneumonia, including the two best documented: dysphagia and stroke-induced immunodepression syndrome (SIDS). An attempt is made to identify patients in the acute phase of stroke who should be evaluated for the risk of developing pneumonia, and tools useful in the identification of such patients (A2DS2, ISAN scoring systems) are discussed. Also, based on expert recommendations, measures to minimise the risk of stroke-related pneumonia are proposed, and the recommended therapeutic regimen is described.