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Abstract
Background and PurposeStroke-associated pneumonia (SAP) is a common complication and an important cause of death during hospitalization. The A2DS2 (Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity) score was developed from the Berlin Stroke Registry and showed good predictive value for predicting SAP. We sought to identify the association between the A2DS2 score and SAP, and, furthermore, to identify whether the A2DS2 score was a predictor for in-hospital death after acute ischemic stroke in a Chinese population.MethodsThis was a retrospective study. 1239 acute ischemic stroke patients were classified to low A2DS2 group (0–4) and high A2DS2 score (5–10) group. Primary outcome was in-hospital SAP. Logistic regression analyses were performed to identify the association between the A2DS2 score and SAP, and also the association between the A2DS2 score and in-hospital death.ResultsThe overall incidence rates of SAP and in-hospital mortality after acute ischemic stroke were 7.3% and 2.4%, respectively. The incidence rate of SAP in low and high A2DS2 score groups was separately 3.3% and 24.7% (P<0.001). During hospitalization, 1.2% patients in low score group and 7.8% patients in high score group died (P<0.001). Multivariate regression demonstrated that patients in high score group had a higher risk of SAP (OR = 8.888, 95%CI: 5.552–14.229) and mortality (OR = 7.833, 95%CI: 3.580–17.137) than patients in low score group.ConclusionsThe A2DS2 score was a strong predictor for SAP and in-hospital death of Chinese acute ischemic stroke patients. The A2DS2 score might be a useful tool for the identification of patients with a high risk of SAP and death during hospitalization.
Highlights
Stroke-associated pneumonia (SAP) is a common medical complication after stroke, with rates reported between 5.6% and 37.98% [1,2,3,4,5,6,7,8,9,10,11]
We sought to identify the association between the A2DS2 score and SAP, and, to identify whether the A2DS2 score was a predictor for in-hospital death after acute ischemic stroke in a Chinese population
The A2DS2 score was a strong predictor for SAP and in-hospital death of Chinese acute ischemic stroke patients
Summary
Stroke-associated pneumonia (SAP) is a common medical complication after stroke, with rates reported between 5.6% and 37.98% [1,2,3,4,5,6,7,8,9,10,11]. To effectively evaluate the risk of SAP, several scales have been developed, including Kwon’s pneumonia score[17], Sellars’s predictive model[2], Chumbler’s 3-level scoring system[18], Ji’s AIS-APS (acute ischemic strokeassociated pneumonia score)[20], and Smith’s ISAN score[23] These scoring systems are not widely used in routine clinical practice due to small sample size[17], lack of validation [17,18], retrospective nature[18], the unavailability or delayed availability for obtaining predictors(e.g., low abbreviated mental test scores, chronic obstructive pulmonary disease, congestive heart failure)[2,20] and the inability to incorporate important risk factors (e.g., dysphagia) [21,23]. We sought to identify the association between the A2DS2 score and SAP, and, to identify whether the A2DS2 score was a predictor for in-hospital death after acute ischemic stroke in a Chinese population.
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