Analysis Of Risk Factors And The Etiology Feature In Patients With Acute Stroke-Associated Pneumonia

Background and ObjectivesThrough the analysis of clinical cases, this study aims to investigate the morbidity and mortality of acute stroke-associated pneumonia (SAP) in our hospital,and to explore the risk factors and etiology feature of sputum culture for SAP, providing a reference for the prevention and clinical treatment of SAP.Objects and MethodsA retrospective study was designed to analyze the clinical information of116cases of patients with acute stroke (admitted to hospital within7days after the illness) treated in neurology department in the Second Affiliated Hospital of Zhengzhou University during Oct2011to Sep2012. To investigate the morbidity and mortality of SAP. and to collect information as follows:The patient’s age, gender, medical history, the length of hospital stay,type and position of stroke, swallowing function, conscious state,plasma albumin levels on admission, NIHSS score and some relevant health care measures before the presence of SAP.Searching for the optimum cut-off points of NIHSS score, age and the length of hospital stay by the way of applying the receiver operating characteristic curve (ROC curve),so that the quantitative data can be converted to classification variables. Second, select all statistically significant factors with a P value of less than0.05in the univariate analysis to the Binary Logistic Regression for the multivariate analysis, to explore possible risk factor for SAP. Last, pathogens were identified through sputum culture, and etiology characteristics were discussed as well.Results(1) It contains116patients with acute stroke in this study, and19.8%of them suffered from SAP. The mortality of the SAP group was21.7%, while in the group without SAP (nSAP) it was1.1%, and there was statistical difference (P<0.05) between the two groups. Compared with late-onset pneumonia, early-onset pneumonia accounted for65.2%, with a mortality rate of26.7%, while the deaths was12.5%in the late-onset pneumonia group, and the difference between them had not statistical significance. We also found that patients had shorter length of stay in nSAP group than in SAP group, and the difference was statistically significant (P<0.05).(2) In univariate analysis there was statistical difference (P<0.05) between the two groups divided by age, the length of hospital stay, NIHSS score on admission, hypoalbuminemia, dysphagia, conscious state, the treatment before SAP (dehydrant, acid inhibitors, antibiotic) and medical operations (tube feeding, assisted ventilation). Binary Logistic Regression for the multivariate analysis indicated that dysphagia, conscious state and hypoalbuminemia on admission were the risk factors for SAP.(3) Sputum culture showed that gram-negative bacilli accounted for79.2%, followed by gram-positive cocci and fungi. The top three of the gram-negative bacteria were klebsiella pneumoniae, pseudomonas aeruginosa and acinetobacter baumannii.Conclusions(1) There is a high morbidity rate for SAP, and most of which occur within3days after stroke onset. Patients with SAP have a higher mortality rate and longer length of stay.(2) SAP is the outcome of combined action of multiple factors. Ddysphagia, conscious state and hypoalbuminemia on admission may be some of the most important risk factors for SAP occurred.(3) The main pathogenic bacteria from sputum culture in SAP patients are gram- negative bacilli, followed by gram-positive cocci and fungi.Most of which are conditional pathogenic bacteria and exist simultaneously.And the species composition is relatively consistent between SAP and nosocomial infection, so maybe they have similar infection mechanism.