Acute Ischemic Stroke Associated Pneumonia Risk Factors And Influence On Prognosis

ObjectiveThe purpose of this study was to discuss the risk factors for stroke-associated pneumonia (SAP) and prognosis on acute ischemic stroke patients for providing the basis of clinical prevention and treatment.MethodsA case-control study was conducted in144 hospitalized patients with acute ischemic stroke admitted in the department of neurology general ward of the Second Affiliated Hospital of Chongqing Medical University between January,2013 and January,2015. According to diagnostic criteria, the patients were divided into SAP and non-SAP group. Medical record data (age, gender, smoking history, history of hypertension, diabetes, heart disease, atrial fibrillation, old cerebral infarction, chronic obstructive pulmonary disease), clinical feature (temperature, blood pressure, dysphagia, pulmonary physical examination), laboratory data (fasting blood-glucose, glycolsylated hemoglobin, low density lipoprotein cholesterol, white blood cell count, albumin), imaging findings (chest X-ray or CT findings, stroke location and volume on cranial CT or MRI, whether combine with leukoaraiosis and severity), disease severity assessment and prognosis evaluation (duration of hospitalization, NIHSS score and modified Rankin scale at admission and discharge, whether death in hospital) were collected. Single factor and multiple factors Logistic regression analysis the related risk factors of SAP and influence on prognosis.Results46 diagnosed with SAP in 144 patients of acute ischemic stroke. Single fact or analysis showed that rate of age≥70 years, hypertension, heart disease, atrial fibrillation, chronic obstructive pulmonary disease, old cerebral infarction, disturbance of consciousness, dysphagia, white blood cell count, diastolic blood pressure, NIHSS score and modified Rankin scale at admission, stroke location (especially insular) and volume, leukoaraiosis in SAP group were significantly higher than those in non-SAP group (P<0.05). In multiply factors regression analysis showed that insular stroke and dysphagia were independent risk factors. Insular stroke OR=5.64,95%CI [1.41-22.64], P=0.015, dysphagia OR=11.48, 95%CI[2.54-5.97], P=0.002. Duration of hospitalization, discharge modified Rankin score, mortality in SAP group were significantly higher than those in non-SAP group(P< 0.05). MRS>4 score as dependent variable showed that heart disease OR=3.84,95%CI[1.31-11.26], P=0.14^ MRS at admission OR=2.40,95%CI[1.11-5.18], P=0.03) stroke volume OR=1.002,95%CI[1.000-1.004], P=0.04)。ConclusionInsular stroke and dysphagia were independent risk factors for SAP. If acute ischemic stroke patients accompanied with heart disease, MRS>4 score at discharge (moderately severe、severe disability、dead) risk increased 3.84 times.MRS at admission increased 1 score, MRS≥4 score at discharge (moderately severe、severe disability、dead) possibility increased 2.4 times. Stroke volume increased 1 mm3, MRS≥4 score at discharge (moderately severe、severe disability、dead) occurrence risk increased 1 times. Patients with acute ischemic stroke complicated by SAP leaded clinical symptoms worsen, prolonged hospitalization, poor prognosis and increased mortality. We should improve the recognition and importance for risk factors of SAP, give timely and effective prevention and treatment measures, to improve the prognosis of patients with acute ischemic stroke.