1
|
Li X, Xie X, Cheng S, Luo S, Zhu Y, Wu K. Predictive Value of Serum Inflammatory Factors and FT3 for Stroke-Associated Pneumonia in Patients With Acute Ischemic Stroke. Neurologist 2024:00127893-990000000-00142. [PMID: 38853767 DOI: 10.1097/nrl.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
OBJECTIVE The ability of serum inflammatory factors and free triiodothyronine (FT3) in predicting the occurrence of stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) was assessed in this study. METHODS A retrospective analysis was conducted on 285 consecutive patients with AIS initially diagnosed and admitted to our hospital from January to December 2022. Patients were categorized into SAP and non-SAP groups based on the presence of SAP. Both groups were compared in terms of baseline characteristics, including National Institute of Health Stroke Scale (NIHSS) score, SAP risk assessment (A2DS2), TOAST classification. Independent risk factors for SAP were identified using multivariate logistic regression analysis, and the predictive value of inflammatory markers was evaluated through ROC curves. RESULTS Among 285 patients with AIS, 40 (14.03%) were found to have developed SAP. Higher NIHSS and A2DS2 scores, elevated serum IL-1β, IL-8, and IL-33 levels, increased age, atrial fibrillation, swallowing difficulties, and a higher proportion of patients with low FT3 levels were observed in the SAP group compared with the non-SAP group (all P<0.05). Significant risk factors for SAP in patients with AIS were identified through multivariate logistic regression analysis, including age, swallowing difficulties, NIHSS, A2DS2 , IL-1β , IL-8 , IL-33, and FT3 (P<0.05). The highest predictive values were observed for A2DS2, FT3, and IL-8 with AUC values of 0.854, 0.844, and 0.823, respectively. CONCLUSION SAP can be highly predicted by A2DS2, FT3, and IL-8, enabling the early identification of patients with high-risk SAP and facilitating timely intervention and treatment.
Collapse
Affiliation(s)
- Xin Li
- Yunnan Key Laboratory of Laboratory Medicine
- Yunnan Province Clinical Research Center for Laboratory Medicine
- Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University
| | - Xiaomei Xie
- Department of Clinical Laboratory, Kunming Tongren Hospital
| | - Shenju Cheng
- Yunnan Key Laboratory of Laboratory Medicine
- Yunnan Province Clinical Research Center for Laboratory Medicine
- Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University
| | - Shan Luo
- Yunnan Key Laboratory of Laboratory Medicine
- Yunnan Province Clinical Research Center for Laboratory Medicine
- Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University
| | - Yancui Zhu
- Department of Intensive Care Unit, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kun Wu
- Yunnan Key Laboratory of Laboratory Medicine
- Yunnan Province Clinical Research Center for Laboratory Medicine
- Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University
| |
Collapse
|
2
|
Qiu H, Luan X, Mei E. High fibrinogen-prealbumin ratio (FPR) predicts stroke-associated pneumonia. J Stroke Cerebrovasc Dis 2024; 33:107703. [PMID: 38556069 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Although numerous factors had been found to be associated with stroke-associated pneumonia (SAP), the underlying mechanisms of SAP remain unclear. Fibrinogen-prealbumin ratio (FPR) is a novel indicator that could balance the effects of inflammation and nutrition, which might reflect biological status of patients more comprehensively than other biomarkers. To date, FPR has not been explored in acute ischemic stroke patients. This study aims to explore the relationship between FPR and SAP. MATERIALS AND METHODS 900 stroke patients participated in this retrospective study and 146 healthy controls were recruited. Fibrinogen and prealbumin were measured within 24 hours on admission. FPR was calculated after dividing fibrinogen (g/L) by prealbumin (mg/L) × 1000. SAP was defined according to the modified Centers for Disease Control criteria. RESULTS 121 patients were diagnosed with SAP. Log10FPR was higher in stroke patients than healthy controls. In logistic regression analysis, log10FPR was independently associated with SAP (OR 15.568; 95% CI: 3.287-73.732; P=0.001). Moreover, after using ROC curve, the predictive power of "current standard"(defined as A2DS2 plus leukocyte count and log10hs-CRP) plus log10FPR (0.832[0.804-0.857]) was higher than "current standard" (0.811[0.782-0.837], P=0.0944) and A2DS2 plus log10FPR (0.801[0.772-0.828], P=0.0316). No significant difference was found between the predictive power of A2DS2 plus log10FPR and "current standard" (P =0.6342). CONCLUSION Higher FPR was observed in stroke patients compared with healthy controls and was significantly associated with SAP. FPR might provide useful clues for timely identification and treatment of SAP.
Collapse
Affiliation(s)
- Huihua Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Enci Mei
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| |
Collapse
|
3
|
Fluck D, Fry CH, Robin J, Affley B, Kakar P, Sharma P, Han TS. Impact of healthcare-associated infections within 7-days of acute stroke on health outcomes and risk of care-dependency: a multi-centre registry-based cohort study. Intern Emerg Med 2024; 19:919-929. [PMID: 38517643 PMCID: PMC11186937 DOI: 10.1007/s11739-024-03543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/16/2024] [Indexed: 03/24/2024]
Abstract
Healthcare-associated infections (HCAIs) in patients admitted with acute conditions remain a major challenge to healthcare services. Here, we assessed the impact of HCAIs acquired within 7-days of acute stroke on indicators of care-quality outcomes and dependency. Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for 3309 patients (mean age = 76.2 yr, SD = 13.5) admitted to four UK hyperacute stroke units (HASU). Associations between variables were assessed by multivariable logistic regression (odds ratios, 95% confidence intervals), adjusted for age, sex, co-morbidities, pre-stroke disability, swallow screening, stroke type and severity. Within 7-days of admission, urinary tract infection (UTI) and pneumonia occurred in 7.6% and 11.3% of patients. Female (UTI only), older age, underlying hypertension, atrial fibrillation, previous stroke, pre-stroke disability, intracranial haemorrhage, severe stroke, and delay in swallow screening (pneumonia only) were independent risk factors of UTI and pneumonia. Compared to patients without UTI or pneumonia, those with either or both of these HCAIs were more likely to have prolonged stay (> 14-days) on HASU: 5.1 (3.8-6.8); high risk of malnutrition: 3.6 (2.9-4.5); palliative care: 4.5 (3.4-6.1); in-hospital mortality: 4.8 (3.8-6.2); disability at discharge: 7.5 (5.9-9.7); activity of daily living support: 1.6 (1.2-2.2); and discharge to care-home: 2.3 (1.6-3.3). In conclusion, HCAIs acquired within 7-days of an acute stroke led to prolonged hospitalisation, adverse health consequences and risk of care-dependency. These findings provide valuable information for timely intervention to reduce HCAIs, and minimising subsequent adverse outcomes.
Collapse
Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, KT18 7EG, UK
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, W6 8RF, UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK.
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| |
Collapse
|
4
|
Xie Z, Xin M, Yu F, Zhu X. Aprepitant Alleviates Poststroke Pneumonia in a Mouse Model of Middle Cerebral Artery Occlusion. Rejuvenation Res 2024; 27:102-109. [PMID: 38666697 DOI: 10.1089/rej.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Elevated substance P can be utilized to predict early mortality during the first week of cerebral infarction. Whether aprepitant, a substance P receptor blocker could be utilized to alleviate poststroke pneumonia which is investigated in this study. Intraluminal monofilament model of middle cerebral artery occlusion (MCAO) was constructed in C57BL/6J male mice, and the relative expression of substance P was detected in collected bronchoalveolar lavage fluid (BALF) and lung tissue homogenate at 24 hours, 48 hours, and 72 hours poststroke. On the other hand, different concentrations of aprepitant (0.5, 1, and 2 mg/kg) were atomized and inhaled into MCAO mice. Inflammation cytokines and bacterial load were detected in collected BALF and lung tissue homogenate at 72-hour poststroke, and lung injury was revealed by histological examination. Aprepitant administration decreased total proteins, total cells, neutrophils, and macrophages in BALF. The concentrations of interleukin (IL)-6, IL-1β, tumor necrosis factor-α, interferon γ, monocyte chemoattractant protein-1, and IL-10 in lung tissue homogenates were also diminished by the administration of aprepitant. In conclusion, aprepitant could attenuate poststroke pneumonia in mice suggesting its potential therapeutic use in the clinic.
Collapse
Affiliation(s)
- Zhihui Xie
- Department of Infectious Disease, Zibo Central Hospital, Zibo, People's Republic of China
| | - Minghui Xin
- Department of Clinical Laboratory, Zibo Central Hospital, Zibo, People's Republic of China
| | - Fatao Yu
- Department of Infectious Disease, Zibo Central Hospital, Zibo, People's Republic of China
| | - Xiaolin Zhu
- Department of Infectious Disease, Zibo Central Hospital, Zibo, People's Republic of China
| |
Collapse
|
5
|
Zhu H, Liang W, Zhu J, He X, Zou P, Yang K, Li G, Liao B, Deng H, Liang Z, Zhao J, Zhao Z, Chen J, He Q, Ning W. Nomogram to predict ventilator-associated pneumonia in large vessel occlusion stroke after endovascular treatment: a retrospective study. Front Neurol 2024; 15:1351458. [PMID: 38803642 PMCID: PMC11129686 DOI: 10.3389/fneur.2024.1351458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background Ventilator-Associated Pneumonia (VAP) severely impacts stroke patients' prognosis after endovascular treatment. Hence, this study created a nomogram to predict the occurrence of VAP after endovascular treatment. Methods The individuals with acute ischemic stroke and large vessel occlusion (AIS-LVO) who received mechanical ventilation and endovascular therapy between July 2020 and August 2023 were included in this retrospective study. The predictive model and nomogram were generated by performing feature selection optimization using the LASSO regression model and multifactor logistic regression analysis and assessed the evaluation, verification and clinical application. Results A total of 184 individuals (average age 61.85 ± 13.25 years, 73.37% male) were enrolled, and the rate of VAP occurrence was found to be 57.07%. Factors such as the Glasgow Coma Scale (GCS) score, duration of stay in the Intensive Care Unit (ICU), dysphagia, Fazekas scale 2 and admission diastolic blood pressure were found to be associated with the occurrence of VAP in the nomogram that demonstrating a strong discriminatory power with AUC of 0.862 (95% CI, 0.810-0.914), and a favorable clinical net benefit. Conclusion This nomogram, comprising GCS score, ICU duration, dysphagia, Fazekas scale 2 and admission diastolic blood pressure, can aid clinicians in predicting the identification of high-risk patients for VAP following endovascular treatment in large vessel occlusion stroke.
Collapse
Affiliation(s)
- Huishan Zhu
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Wenfei Liang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jingling Zhu
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Xiaohua He
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Pengjuan Zou
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Kangqiang Yang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Guoshun Li
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Bin Liao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Huiquan Deng
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Zichong Liang
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jiasheng Zhao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Zhan Zhao
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Jingyi Chen
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| | - Qiuxing He
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weimin Ning
- Department of Neurology, Dongguan Hospital of Guangzhou University of Chinese Medicine, Dongguan, China
| |
Collapse
|
6
|
Ahmad M, Ayaz Z, Sinha T, Soe TM, Tutwala N, Alrahahleh AA, Arrey Agbor DB, Ali N. Risk Factors for the Development of Pneumonia in Stroke Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e57077. [PMID: 38681338 PMCID: PMC11052642 DOI: 10.7759/cureus.57077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Pneumonia is one of the most prevalent medical complications post-stroke. It can have negative impacts on the prognosis of stroke patients. This study aimed to determine the predictors of pneumonia in stroke patients. The authors devised, reviewed, and enhanced the search strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were gathered from various electronic databases, including Medline, CINAHL, Cochrane, Embase, and Web of Science, from January 1st, 2011, to February 25th, 2024. The review encompassed studies involving patients aged 18 years and older who were hospitalized for acute stroke care. Inclusion criteria required patients to have received a clinical diagnosis of stroke, confirmed via medical imaging (CT or MRI), hospital primary diagnosis International Classification of Diseases 10th Revision discharge codes, or pathology reporting. A total of 35 studies met the criteria and were included in our pooled analysis. Among them, 23 adopted a retrospective design, while the remaining 12 were prospective. The pooled incidence of pneumonia among patients with stroke was found to be 14% (95% confidence interval = 13%-15%). The pooled analysis reported that advancing age, male gender, a history of chronic obstructive pulmonary disease (COPD), the presence of a nasogastric tube, atrial fibrillation, mechanical ventilation, stroke severity, dysphagia, and a history of diabetes were identified as significant risk factors for pneumonia development among stroke patients. Our results underscore the importance of proactive identification and management of these factors to mitigate the risk of pneumonia in stroke patients.
Collapse
Affiliation(s)
| | - Zeeshan Ayaz
- Medicine, Rehman Medical Institute, Peshawar, PAK
| | - Tanya Sinha
- Medical Education, Tribhuvan University, Kirtipur, NPL
| | - Thin M Soe
- Medicine, University of Medicine 1, Yangon, Yangon, MMR
| | - Nimish Tutwala
- Obstetrics and Gynaecology, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, IND
| | | | - Divine Besong Arrey Agbor
- Clinical Research and Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Neelum Ali
- Internal Medicine, University of Health Sciences, Lahore, PAK
| |
Collapse
|
7
|
Luo H, Li J, Chen Y, Wu B, Liu J, Han M, Wu Y, Jia W, Yu P, Cheng R, Wang X, Ke J, Xian H, Tu J, Yi Y. Feasibility of a clinical-radiomics combined model to predict the occurrence of stroke-associated pneumonia. BMC Neurol 2024; 24:45. [PMID: 38273251 PMCID: PMC10809767 DOI: 10.1186/s12883-024-03532-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To explore the predictive value of radiomics in predicting stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients and construct a prediction model based on clinical features and DWI-MRI radiomics features. METHODS Univariate and multivariate logistic regression analyses were used to identify the independent clinical predictors for SAP. Pearson correlation analysis and the least absolute shrinkage and selection operator with ten-fold cross-validation were used to calculate the radiomics score for each feature and identify the predictive radiomics features for SAP. Multivariate logistic regression was used to combine the predictive radiomics features with the independent clinical predictors. The prediction performance of the SAP models was evaluated using receiver operating characteristics (ROC), calibration curves, decision curve analysis, and subgroup analyses. RESULTS Triglycerides, the neutrophil-to-lymphocyte ratio, dysphagia, the National Institutes of Health Stroke Scale (NIHSS) score, and internal carotid artery stenosis were identified as clinically independent risk factors for SAP. The radiomics scores in patients with SAP were generally higher than in patients without SAP (P < 0. 05). There was a linear positive correlation between radiomics scores and NIHSS scores, as well as between radiomics scores and infarct volume. Infarct volume showed moderate performance in predicting the occurrence of SAP, with an AUC of 0.635. When compared with the other models, the combined prediction model achieved the best area under the ROC (AUC) in both training (AUC = 0.859, 95% CI 0.759-0.936) and validation (AUC = 0.830, 95% CI 0.758-0.896) cohorts (P < 0.05). The calibration curves and decision curve analysis further confirmed the clinical value of the nomogram. Subgroup analysis showed that this nomogram had potential generalization ability. CONCLUSION The addition of the radiomics features to the clinical model improved the prediction of SAP in AIS patients, which verified its feasibility.
Collapse
Affiliation(s)
- Haowen Luo
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
| | - Jingyi Li
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Yongsen Chen
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Bin Wu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Jianmo Liu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
| | - Mengqi Han
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Yifan Wu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Weijie Jia
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Pengfei Yu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
| | - Rui Cheng
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Xiaoman Wang
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Jingyao Ke
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Hongfei Xian
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China
- School of Public Health, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China.
| | - Yingping Yi
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, 1MinDe Road, Nanchang, 330006, P.R. China.
| |
Collapse
|
8
|
Fluck D, Fry CH, Robin J, Affley B, Kakar P, Sharma P, Han TS. Determination of independent risk factors for early healthcare-associated infections acquired after acute stroke admission: A multi-centre registry-based cohort study. J Stroke Cerebrovasc Dis 2023; 32:107402. [PMID: 37804783 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/20/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVE Healthcare-associated infections (HCAIs) in patients admitted with acute conditions pose a serious risk to patients and a major challenge to healthcare services. However, there is a lack of consistency in reporting aetiological risk factors, particularly in acute stroke patients. Here, we determined independent risk factors of two common HCAIs (urinary tract infection and pneumonia) acquired within 7-days of admission after an acute stroke. METHODS Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for 3,309 patients (mean age=76.2yr, SD=13.5) admitted to four UK hyperacute stroke units. Associations between variables were assessed by forward stepwise multivariable logistic regression (odds ratios, 95 % confidence intervals). RESULTS The rate of urinary tract infection and/or pneumonia occurring within 7-days of admission was 15.0 %. The risk of urinary tract infection and/or pneumonia was increased amongst women: OR = 1.35 (1.08-1.68); patients from ethnic minority backgrounds: OR = 1.77 (1.01-3.10); patients aged 70-79 years: OR = 2.08 (1.42-3.06), and ≥80 years: OR = 3.20 (2.26-4.55); history of hypertension: OR = 1.59 (1.27-1.98); history of atrial fibrillation: OR = 1.67 (1.32-2.12); pre-stroke disability: OR = 2.08 (1.44-3.00); intracranial haemorrhage: OR = 1.41 (1.07-1.86); severe stroke: OR = 3.21 (2.32-4.45); swallow screening within 4-72 h: OR = 1.42 (1.08-1.86); swallow screening beyond 72 h: OR = 1.70 (1.08-2.70). History of congestive heart failure, diabetes and previous stroke did not significantly associate with HCAIs. CONCLUSIONS A profile of independent risk factors for two common HCAIs in acute stroke was identified. These findings provide valuable information for timely intervention to reduce HCAIs, and the ability to minimise subsequent adverse outcomes.
Collapse
Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD UK3
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom KT18 7EG, UK
| | - Pankaj Sharma
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London W6 8RF, UK; Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK; Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| |
Collapse
|
9
|
Wang C, Jiang X, Wu D, Ge M, Deng L. GNRI, PLR and Stroke-Associated Pneumonia: From Association to Development of a Web-Based Dynamic Nomogram. Clin Interv Aging 2023; 18:1893-1904. [PMID: 38020451 PMCID: PMC10661926 DOI: 10.2147/cia.s433388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Discussing the relationship between geriatric nutritional risk index (GNRI) and platelet-to-lymphocyte ratio (PLR) on stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients, developing and validating a web-based dynamic nomogram. Methods A total of 996 AIS patients admitted to the Department of General Medicine and Neurology at Xuzhou Medical University Affiliated Hospital were collected. They were divided into Non-SAP group and SAP group based on the occurrence of SAP. The data was randomly divided into training set and validation set in a ratio of 7:3. LASSO regression and multivariable logistic regression analysis were used to screen for independent risk factors and develop a dynamic nomogram. Area under the receiver operating characteristic curve (AUC-ROC), calibration curve, and decision curve analysis (DCA) curve were used to validate the model's discriminative ability, calibration, and clinical value, respectively. Results Among AIS patients, a total of 221 cases (22.19%) developed SAP. Age, NIHSS score, comorbid atrial fibrillation, dysphagia, PLR, and GNRI were identified as independent factors influencing the occurrence of SAP in AIS patients. A web-based dynamic nomogram was developed based on these six variables. The training set showed an AUC-ROC of 0.864 (95% CI: 0.828-0.892), while the validation set showed an AUC-ROC of 0.825 (95% CI: 0.772-0.882), indicating good predictive ability and discrimination of the model. The calibration curve demonstrated good calibration of the model, and the DCA curve showed its clinical value. This model can be accessed and utilized by anyone on the website (https://moonlittledoctor.shinyapps.io/ANADPG/). Conclusion PLR and GNRI are independent factors influencing the occurrence of SAP in AIS patients, and a dynamic nomogram was constructed to predict the risk of SAP in AIS patients. It can guide clinical decision-making and improve patient prognosis.
Collapse
Affiliation(s)
- Chunqing Wang
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Xiaoyao Jiang
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Di Wu
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Mengjun Ge
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Li Deng
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| |
Collapse
|
10
|
Li S, Zhang Y, Zhang X, Zhang G, Han N, Ma H, Ge H, Zhao Y, Zhang L, Wang Y, Shi W, Ma X, Tian Y, Xiao Y, Niu Y, Qiao L, Chang M. The Functional Prognosis of Rescue Conscious Sedation During Mechanical Thrombectomy on Patients with Acute Anterior Circulation Ischemic Stroke: A Single-Center Retrospective Study. Neurol Ther 2023; 12:1777-1789. [PMID: 37531028 PMCID: PMC10444930 DOI: 10.1007/s40120-023-00528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Based on real-world case data, this study intends to explore and analyze the impact of rescue conscious sedation (CS) on the clinical outcomes of patients with anterior circulation acute ischemic stroke (AIS) receiving mechanical thrombectomy (MT). METHODS This retrospective study enrolled patients with anterior circulation AIS who received MT and were treated with either single local anesthesia (LA) or rescue CS during MT between January 2018 and October 2021. We used univariate and multivariate logistic regression methods to compare the impact of LA and CS on the clinical outcomes of patients with AIS who received MT, including the mRS at 90 days, the incidence of poststroke pneumonia (PSP), the incidence of symptomatic intracranial cerebral hemorrhage (sICH), and the mortality rate. RESULTS We reviewed 314 patient cases with AIS who received MT. Of all patients, 164 met our search criteria. Eighty-nine patients received LA, and 75 patients received rescue CS. There was no significant difference between the two groups in the 90-day good prognosis (45.3% vs. 51.7%, p = 0.418) and mortality (17.3% vs. 22.5%, p = 0.414). Compared with the LA group, the incidence of postoperative pneumonia in the rescue CS group (44% vs. 25.8%, p = 0.015) was more significant. Multivariate stepwise logistic regression analysis revealed that intraoperative remedial CS was independently associated with PSP following MT. In a subgroup analysis, rescue CS was found to significantly increase the incidence of PSP in patients with dysphagia (OR = 7.307, 95% CI 2.144-24.906, p = 0.001). As the severity of the National Institutes of Health Stroke Scale (NIHSS) increased, intraoperative rescue CS was found to increase the risk of PSP (OR = 1.155, 95% CI 1.034-1.290, p = 0.011) by 5.1% compared to that of LA (OR = 1.104, 95% CI 1.013-1.204, p = 0.024). CONCLUSION Compared to LA, rescue CS during MT does not significantly improve the 90 days of good prognosis and reduce the incidence of sICH and mortality in patients with anterior circulation AIS. However, it has a significantly increased risk of poststroke pneumonia (PSP), particularly in patients with dysphagia.
Collapse
Affiliation(s)
- Shilin Li
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China
| | - Yu Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Xiaobo Zhang
- The College of Life Sciences, Northwest University, Xi'an, China
| | - Gejuan Zhang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China
| | - Nannan Han
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China
| | - Haojun Ma
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China
| | - Hanming Ge
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China
| | - Yong Zhao
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China
| | - Leshi Zhang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China
| | - Yanfei Wang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China
| | - Wenzhen Shi
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Medical Research Center, The Aliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, China
| | - Xiaojuan Ma
- Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Medical Research Center, The Aliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, China
| | - Yizhuo Tian
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, China
| | - Yixuan Xiao
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, China
| | - Yinuo Niu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, China
| | - Lin Qiao
- Department of Anesthesiology, Xi'an No.5 Hospital, Xi'an, China
| | - Mingze Chang
- Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China.
| |
Collapse
|
11
|
Bouddhara T, Persondek L, Ablah E, Okut H, Lu L, Walker J. Post-stroke pneumonia: Factors associated with readmission within 90 days of stroke discharge. J Stroke Cerebrovasc Dis 2023; 32:107276. [PMID: 37611514 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE The objective was to identify risk and protective factors associated with post-stroke pneumonia readmission. METHOD A retrospective chart review was conducted on 365 stroke patients who were admitted to Ascension Via Christi St. Francis Hospital in Wichita, Kansas from January 1, 2015 through January 30, 2020. This case control study used matching by age at a proportion of four control patients to one post-stroke pneumonia patient. Patients with and without post-stroke pneumonia readmission within 90 days of discharge were included in this study. RESULTS Of the 3,952 patients diagnosed with stroke, 1.8% (n=73) patients were readmitted with post-stroke pneumonia. Compared to patients who were not readmitted for post-stroke pneumonia, patients with post-stroke pneumonia readmission were more likely to: have used a nasogastric tube during index admission, have used mechanical ventilation during index admission, or have been placed on a nothing-by-mouth diet at discharge. Being placed on nothing-by-mouth for fluids was also a predictor of post-stroke pneumonia readmission. Lack of acquired infection during the index admission was a protective factor for post-stroke pneumonia readmission. DISCUSSION The pathophysiology of post-stroke pneumonia is multifactorial and includes consideration of dysphagia severity, bacterial colonization of the oropharynx and feeding tube, and an altered immune system. CONCLUSION During the index admission, patients on nothing-by-mouth were more likely to be readmitted, and infection-free patients were less likely to be readmitted with post-stroke pneumonia. By identifying at-risk patients, clinicians may be able to use this information to tailor future medical interventions to prevent post-stroke pneumonia readmissions.
Collapse
Affiliation(s)
- Tiffany Bouddhara
- Department of Anesthesiology, The University of Kansas School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214, United States.
| | - LeighAnn Persondek
- Neurocritical Care and Acute Stroke Program, Ascension Via Christi St. Francis, Wichita, KS 67214, United States
| | - Elizabeth Ablah
- Department of Population Health, The University of Kansas School of Medicine-Wichita, Wichita, KS 67214, United States
| | - Hayrettin Okut
- Department of Population Health, The University of Kansas School of Medicine-Wichita, Wichita, KS 67214, United States
| | - Liuqiang Lu
- Department of Population Health, The University of Kansas School of Medicine-Wichita, Wichita, KS 67214, United States
| | - James Walker
- Department of Anesthesiology, The University of Kansas School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214, United States; Neurocritical Care and Acute Stroke Program, Ascension Via Christi St. Francis, Wichita, KS 67214, United States
| |
Collapse
|
12
|
Yang ZC, Yong ZZ, Hua L, Li WC. Superiority of Percutaneous Endoscopic Gastrostomy Over Nasogastric Feeding for Stroke-Induced Severe Dysphagia: A Comparative Study. Med Sci Monit 2023; 29:e940613. [PMID: 37766420 PMCID: PMC10546899 DOI: 10.12659/msm.940613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Patients with dysphagia due to stroke may require enteral feeding using either a nasogastric (NG) feeding tube or a percutaneous endoscopic gastrostomy (PEG) tube. This study aimed to compare outcomes from NG tube and PEG tube feeding in 40 patients with severe dysphagia due to stroke. MATERIAL AND METHODS We enrolled 40 patients admitted to the hospital from April 2019 to December 2022 due to severe stroke dysphagia, who were divided into the gastrostomy group (20 patients) and the nasogastric feeding group (20 patients) in accordance with the random number table method. Percutaneous endoscopic gastrostomy was performed in both groups and we assessed differences in swallowing function, nutritional recovery, safety, and hope levels. RESULTS Standardized Swallowing Assessment (SSA) scores in both groups clearly decreased after the intervention, but there was greater reduction in the gastrostomy group (P<0.001). Both groups had distinct improvements of the levels of a variety of nutritional indicators after the intervention, but there was greater improvement in the gastrostomy group (P<0.001). The gastrostomy group also had fewer overall complications (P<0.001). Herth Hope Scale scores in both groups were significantly increased after intervention, and the gastrostomy group had a larger increase that the nasogastric feeding group (P<0.001). CONCLUSIONS Compared with nasogastric tube feeding, percutaneous endoscopic gastrostomy has advantages in SSA score, protein level, and Herth Hope Scale in the treatment of stroke patients with dysphagia.
Collapse
Affiliation(s)
- Zhong Chang Yang
- Department of Cerebrovascular Diseases, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, PR China
| | - Zhang Zu Yong
- Department of Neurosurgery, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, PR China
| | - Li Hua
- Admission Preparation Center, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, PR China
| | - Wu Chun Li
- Department of Cerebrovascular Diseases, Hangzhou Third People’s Hospital, Hangzhou, Zhejiang, PR China
| |
Collapse
|
13
|
Wu B, Peng M, Tong Y, Wang X, Ding Y, Cheng X. Distribution of bacteria and risk factors in patients with multidrug-resistant pneumonia in a single center rehabilitation ward. Medicine (Baltimore) 2023; 102:e35023. [PMID: 37682183 PMCID: PMC10489429 DOI: 10.1097/md.0000000000035023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Stroke patients may have dysphagia and frequent aspiration increasing exposure to antibiotics and the chance of multidrug-resistant (MDR) bacteria infection. This study investigated clinical risk factors and related antibiotic use of MDR bacteria infection in stroke patients in the rehabilitation ward, hoping that it can help prevent and reduce the condition of MDR bacteria. A retrospective cohort study was conducted using the database of stroke patients with pneumonia admitted to the rehabilitation ward from January 1, 2020, to June 30, 2022. The selected stroke patients were divided into the MDR and non-MDR groups. Analyze the infection bacteria of the 2 groups. Forward logistic regression was applied to identify possible independent MDR bacteria infection risk factors. A total of 323 patients were included. The top 3 common MDR pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. Almost all Pseudomonas aeruginosa and Acinetobacter baumannii are resistant to ertapenem. National Institute of Health stroke scale at admission was associated with MDR bacteria infection pneumonia (OR [odds ratio] = 1.078, 95%CI [1.017, 1.142]). Long-term tracheotomy (OR = 2.695, 95%CI [1.232, 5.897]), hypoalbuminemia (OR = 473, 95%CI [1.318, 4.642]), and bilateral cerebral hemisphere stroke (OR = 4.021, 95%CI [2.009, 8.048]) were significant clinical risk factors of MDR pneumonia after stroke. The detection rate of MDR bacteria has increased. Understanding the distribution and drug resistance of MDR bacteria in stroke patients with pneumonia in the neurological rehabilitation ward and the related susceptibility of MDR bacteria infection is necessary. This way, the treatment plan can be adjusted more timely, avoiding the abuse of antibiotics.
Collapse
Affiliation(s)
- Bangqi Wu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Maohan Peng
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Respiratory and Critical Care Medicine, Pengzhou People’s Hospital, Pengzhou, China
| | - Yuanyuan Tong
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xuhui Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yi Ding
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinyue Cheng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
14
|
Tashima H, Ito M, Kawakami M, Ishii R, Miyazaki Y, Akimoto T, Tsujikawa M, Kobayashi K, Kondo K, Tsuji T. Risk Factors for Post-Stroke Pneumonia in a Patient Population with Subacute Stroke: A Retrospective Cohort Study. J Clin Med 2023; 12:5835. [PMID: 37762776 PMCID: PMC10532161 DOI: 10.3390/jcm12185835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
The risk of pneumonia and death is higher in acute stroke patients with signs of pulmonary infection on chest computed tomography (CT) at admission. However, few reports have examined the incidence of pneumonia and its predictors in subacute stroke patients. The aim of this study was to examine factors related to post-stroke pneumonia in subacute stroke patients. A total of 340 subacute stroke patients were included. Univariable logistic regression analysis was performed using variables that may contribute to pneumonia, with the development of pneumonia as the dependent variable. Multivariable logistic regression analysis using the three independent variables with the lowest p-values on the univariable logistic regression analysis was also performed to calculate adjusted odds ratios. Twenty-two patients developed pneumonia during hospitalization. The univariable logistic regression analysis showed that the top three items were serum albumin (Alb), functional Oral Intake Scale (FOIS) score, and signs of pulmonary infection on chest CT at admission. Multivariable logistic regression analysis adjusted for these three items showed that the presence of signs of pulmonary infection on chest CT at admission was the independent variable (OR: 4.45; 95% CI: 1.54-12.9). When signs of pulmonary infection are seen on admission chest CT, careful follow-up is necessary because pneumonia is significantly more likely to occur during hospitalization.
Collapse
Affiliation(s)
- Hiroyuki Tashima
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Mari Ito
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki 305-8577, Japan
| | - Yuta Miyazaki
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tomonori Akimoto
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Masahiro Tsujikawa
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Keigo Kobayashi
- Department of Radiology, Yatsu Hoken Hospital, Chiba 275-0026, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| |
Collapse
|
15
|
Vasan V, Hardigan TA, Ali M, Downes M, Devarajan A, Rossitto CP, Schuldt BR, Odland IC, Kellner CP, Fifi JT, Mocco J, Majidi S. Dysphagia after ischemic and hemorrhagic stroke: A propensity-matched 20-year analysis of the national inpatient sample. J Stroke Cerebrovasc Dis 2023; 32:107295. [PMID: 37544059 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/23/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Dysphagia is a common symptom of acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), but little is known surrounding national trends of this post-stroke condition. Hence, this study aimed to identify the risk factors for dysphagia following AIS and ICH and evaluate in-hospital outcomes in these patients. METHODS The 2000-2019 Nationwide Inpatient Sample was queried for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63) and ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 were used in multivariable regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of dysphagia on outcomes. RESULTS Of 10,415,286 patients with AIS, 956,662 (9.2%) had in-hospital dysphagia. Total of 2,000,868 patients with ICH were identified; 203,511 (10.2%) had in-hospital dysphagia. Patients with dysphagia after AIS were less likely to experience in-hospital mortality (OR 0.61;95%CI: 0.60-0.63) or be discharged home (AOR 0.51;95%CI: 0.51-0.52), had increased length of stay (Beta-coefficient = 0.43 days; 95%CI: 0.36-0.50), and had increased hospital charges ($14411.96;95%CI: 13565.68-15257.44) (all p < 0.001). Patients with dysphagia after ICH were less likely to experience in-hospital mortality (AOR 0.39;95%CI: 0.37-0.4), less likely to be discharged home (AOR 0.59,95%CI:0.57-0.61), have longer hospital stay (Beta-coefficient = 1.99 days;95%CI: 1.78-2.21), and increased hospital charges ($28251.93; 95%CI: $25594.57-30909.28)(all p < 0.001). CONCLUSION This is the first study to report on national trends in patients with dysphagia after AIS and ICH. These patients had longer hospital LOS, worse functional outcomes at discharge, and higher hospital costs.
Collapse
Affiliation(s)
- Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA.
| | - Trevor A Hardigan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Margaret Downes
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Christina P Rossitto
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Braxton R Schuldt
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Ian C Odland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| |
Collapse
|
16
|
Abstract
Gastrointestinal (GI) complications are seen in over 50% of ischemic stroke survivors; the most common complications are dysphagia, constipation, and GI bleeding. The bidirectional relationship of the gut-brain axis and stroke has recently gained traction, wherein stroke contributes to gut dysbiosis (alterations in the normal host intestinal microbiome) and gut dysbiosis perpetuates poor functional neurologic outcomes in stroke. It is postulated that the propagation of proinflammatory cells and gut metabolites (including trimethylamine N-oxide and short-chain fatty acids) from the GI tract to the central nervous system play a central role in gut-brain axis dysfunction. In this review, we discuss the known GI complications in acute ischemic stroke, our current knowledge from experimental stroke models for gut-brain axis dysfunction in stroke, and emerging therapeutics that target the gut-brain axis.
Collapse
Affiliation(s)
- Heather Y F Yong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Carlos Camara-Lemarroy
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
17
|
Yang G, Xu M, Chen W, Qiao X, Shi H, Hu Y. A brain CT-based approach for predicting and analyzing stroke-associated pneumonia from intracerebral hemorrhage. Front Neurol 2023; 14:1139048. [PMID: 37332986 PMCID: PMC10272424 DOI: 10.3389/fneur.2023.1139048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Stroke-associated pneumonia (SAP) is a common complication of stroke that can increase the mortality rate of patients and the burden on their families. In contrast to prior clinical scoring models that rely on baseline data, we propose constructing models based on brain CT scans due to their accessibility and clinical universality. Methods Our study aims to explore the mechanism behind the distribution and lesion areas of intracerebral hemorrhage (ICH) in relation to pneumonia, we utilized an MRI atlas that could present brain structures and a registration method in our program to extract features that may represent this relationship. We developed three machine learning models to predict the occurrence of SAP using these features. Ten-fold cross-validation was applied to evaluate the performance of models. Additionally, we constructed a probability map through statistical analysis that could display which brain regions are more frequently impacted by hematoma in patients with SAP based on four types of pneumonia. Results Our study included a cohort of 244 patients, and we extracted 35 features that captured the invasion of ICH to different brain regions for model development. We evaluated the performance of three machine learning models, namely, logistic regression, support vector machine, and random forest, in predicting SAP, and the AUCs for these models ranged from 0.77 to 0.82. The probability map revealed that the distribution of ICH varied between the left and right brain hemispheres in patients with moderate and severe SAP, and we identified several brain structures, including the left-choroid-plexus, right-choroid-plexus, right-hippocampus, and left-hippocampus, that were more closely related to SAP based on feature selection. Additionally, we observed that some statistical indicators of ICH volume, such as mean and maximum values, were proportional to the severity of SAP. Discussion Our findings suggest that our method is effective in classifying the development of pneumonia based on brain CT scans. Furthermore, we identified distinct characteristics, such as volume and distribution, of ICH in four different types of SAP.
Collapse
Affiliation(s)
- Guangtong Yang
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Min Xu
- Neurointensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Wei Chen
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xu Qiao
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Hongfeng Shi
- Neurointensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Yongmei Hu
- School of Control Science and Engineering, Shandong University, Jinan, China
| |
Collapse
|
18
|
Lidetu T, Muluneh EK, Wassie GT. Incidence and Predictors of Aspiration Pneumonia Among Stroke Patients in Western Amhara Region, North-West Ethiopia: A Retrospective Follow Up Study. Int J Gen Med 2023; 16:1303-1315. [PMID: 37089139 PMCID: PMC10115200 DOI: 10.2147/ijgm.s400420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
Background Aspiration pneumonia is one of the major complications among hospitalized stroke patients, with global incidence ranging from 5-83% and hospital mortality rate of up to 70%. This study aimed to assess the incidence and identify predictors of aspiration pneumonia among stroke patients in Western Amhara region, North-West Ethiopia. Methods An institution-based retrospective follow-up study was conducted on a simple random sample of 568 stroke patients in Western Amhara region admitted at Felege Hiwot Referral Hospital. Log binomial regression model, a generalized linear model with log link, was applied to identify significant predictors of aspiration pneumonia. Results Cumulative incidence of aspiration pneumonia among the 568 sampled patients was 23.06%. Males were 1.71 times more at risk to acquire aspiration pneumonia than females (ARR = 1.71, 95% CI 1.07-2.74). Patients with vomiting and dysphagia were at more risk of acquiring aspiration pneumonia as compared with patients without vomiting and dysphagia (ARR = 1.81, 95% CI 1.04-3.14 and ARR = 1.95, 95% CI 1.10-3.48, respectively). Patients who received antibiotic prophylaxis and patients with Glasgow Coma Scale greater than 12 had less risk of acquiring aspiration pneumonia as compared with those who did not receive antibiotic prophylaxis and patients with Glasgow Coma Scale less than 8 (ARR = 0.10, 95% CI 0.04-0.28 and ARR = 0.45, 95% CI 0.22-0.94, respectively). Conclusion The cumulative incidence of aspiration pneumonia among sampled patients was 23.06%. Vomiting, dysphagia, antibiotic treatment and Glasgow Coma Scale showed significant correlation with the acquiring of aspiration pneumonia. Therefore, we recommend health-care providers should give special attention for patients with these risk factors to prevent aspiration pneumonia.
Collapse
Affiliation(s)
- Tadios Lidetu
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | |
Collapse
|
19
|
Potente P, Buoite Stella A, Vidotto M, Passerini M, Furlanis G, Naccarato M, Manganotti P. Application of Ultrasonography in Neurogenic Dysphagia: A Systematic Review. Dysphagia 2023; 38:65-75. [PMID: 35556172 PMCID: PMC9873712 DOI: 10.1007/s00455-022-10459-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 04/22/2022] [Indexed: 01/28/2023]
Abstract
Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce independence, and increase mortality. Rapid identification of dysphagia is necessary to reduce the risk of penetration and aspiration, and to early start rehabilitation protocols. Among the methods that can be used to evaluate dysphagia and its components, ultrasound imaging has been suggested to support the evaluation of dysphagia by providing measures of both static and dynamic anatomical components. The aim of this systematic review is to evaluate the usefulness of ultrasonography in neurogenic dysphagia according to current literature. From 2000 to 2020, 633 studies with the appropriate search terms for ultrasound and dysphagia were identified. After screening them, 10 studies were included in the qualitative analysis. Patients with the following neurologic conditions were studied with ultrasonography for dysphagia: Parkinson's disease, muscle dystrophy, amyotrophic lateral sclerosis, and stroke. The main outcomes of ultrasonography were swallowing muscles thickness (e.g., tongue), and dynamic measures such as hyoid displacement. The different protocols used in the studies, as well as their outcomes, did not allow to provide standard procedures and normative or cut-off values in the presented diseases. Because there are a variety of tools, methods, and techniques that have been used in the studies that were reviewed, it is difficult to evaluate them using established standards. However, ultrasonography correlates well with clinical evaluation of dysphagia and therefore has prognostic and rehabilitation potential. Future studies should aim to develop and utilize a common interdisciplinary protocol that includes standard procedures and outcomes to define normative values applicable in the different conditions.
Collapse
Affiliation(s)
- Paola Potente
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Monica Vidotto
- School of Speech and Language Therapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Michelle Passerini
- School of Speech and Language Therapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
| |
Collapse
|
20
|
Wang J, Liu X, Li Q. Interventional strategies for ischemic stroke based on the modulation of the gut microbiota. Front Neurosci 2023; 17:1158057. [PMID: 36937662 PMCID: PMC10017736 DOI: 10.3389/fnins.2023.1158057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
The microbiota-gut-brain axis connects the brain and the gut in a bidirectional manner. The organism's homeostasis is disrupted during an ischemic stroke (IS). Cerebral ischemia affects the intestinal flora and microbiota metabolites. Microbiome dysbiosis, on the other hand, exacerbates the severity of IS outcomes by inducing systemic inflammation. Some studies have recently provided novel insights into the pathogenesis, efficacy, prognosis, and treatment-related adverse events of the gut microbiome in IS. In this review, we discussed the view that the gut microbiome is of clinical value in personalized therapeutic regimens for IS. Based on recent non-clinical and clinical studies on stroke, we discussed new therapeutic strategies that might be developed by modulating gut bacterial flora. These strategies include dietary intervention, fecal microbiota transplantation, probiotics, antibiotics, traditional Chinese medication, and gut-derived stem cell transplantation. Although the gut microbiota-targeted intervention is optimistic, some issues need to be addressed before clinical translation. These issues include a deeper understanding of the potential underlying mechanisms, conducting larger longitudinal cohort studies on the gut microbiome and host responses with multiple layers of data, developing standardized protocols for conducting and reporting clinical analyses, and performing a clinical assessment of multiple large-scale IS cohorts. In this review, we presented certain opportunities and challenges that might be considered for developing effective strategies by manipulating the gut microbiome to improve the treatment and prevention of ischemic stroke.
Collapse
|
21
|
Fujita A, Iwata M, Hagii J, Metoki N, Shiroto H, Tsuda E. The effects of combined early oral health care and early mobilisation on the incidence of stroke-associated pneumonia. J Stroke Cerebrovasc Dis 2023; 32:106893. [PMID: 36395662 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the effects of combined early oral healthcare and early mobilisation on the incidence of stroke-associated pneumonia during hospitalisation of acute stroke patients. MATERIALS AND METHODS In this single-centre, non-blinded, before-and-after cohort study, patients received basic stroke rehabilitation by a multidisciplinary team within 72 h of symptom onset from July to September 2016 and from July to September 2018. Patients were divided into two groups: 1) patients who received combined early oral healthcare and early mobilisation (early intervention group) (n=107), and 2) patients who received usual care (control group) (n=107). The relationship between the stroke-associated pneumonia incidence and prognosis was examined. RESULTS The early intervention group had a significantly lower incidence of stroke-associated pneumonia than the control group (0.93% vs. 7.48%; P=0.01). Moreover, the early intervention group had a significantly lower proportion of patients who died or required medical care because of recurrent pneumonia at discharge (0.93% vs. 5.6%; P=0.04). In contrast, there were no significant differences between the two groups regarding the Revised Hasegawa's Dementia Scale on day 14 (22.5 vs. 23; P=0.87), Functional Independence Measure on day 14 (112 vs. 116; P=0.06), and rate of total oral diet (Food Intake LEVEL Scale ≥7) at discharge (95.2% vs. 93.5%; P=0.55). CONCLUSIONS Combined early oral healthcare and early mobilisation by a multidisciplinary team significantly decreased the stroke-associated pneumonia incidence within 7 days and reduced the percentage of patients who died or required medical care because of recurrent pneumonia after stroke.
Collapse
Affiliation(s)
- Ayaka Fujita
- Department of Rehabilitation Medicine, Hirosaki University Hospital, Hirosaki, Aomori, Japan.
| | - Manabu Iwata
- Department of Rehabilitation, Hirosaki Stroke and Rehabilitation Centre, Hirosaki, Aomori, Japan.
| | - Joji Hagii
- Department of Internal Medicine, Hirosaki Stroke and Rehabilitation Centre, Hirosaki, Aomori, Japan.
| | - Norifumi Metoki
- Department of Internal Medicine, Hirosaki Stroke and Rehabilitation Centre, Hirosaki, Aomori, Japan.
| | - Hiroshi Shiroto
- Department of Internal Medicine, Hirosaki Stroke and Rehabilitation Centre, Hirosaki, Aomori, Japan.
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
| |
Collapse
|
22
|
Exploring the Influence of Dysphagia and Tracheostomy on Pneumonia in Patients with Stroke: A Retrospective Cohort Study. Brain Sci 2022; 12:brainsci12121664. [PMID: 36552123 PMCID: PMC9775301 DOI: 10.3390/brainsci12121664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Pneumonia is common in patients with tracheostomy and dysphagia. However, the influence of dysphagia and tracheostomy on pneumonia in patients with stroke remains unclear. The aim of this study was to explore the risk factors related to pneumonia, and the association between dysphagia, tracheostomy and pneumonia in patients with stroke was investigated. Methods: Patients with stroke who experienced tracheostomy and dysphagia were included and divided into two groups based on record of pneumonia at discharge. Clinical manifestations and physical examination were used to diagnose pneumonia, whereas clinical swallowing examination, and videofluoroscopy swallowing studies (VFSS) were used to evaluate swallowing function. Results: There were significant differences between the pneumonia group and the no pneumonia group in total tracheostomy time (6.3 ± 5.9 vs. 4.3 ± 1.7 months, p = 0.003), number of instances of ventilator support (0.41 ± 0.49 vs. 0.18 ± 0.38, p = 0.007), PAS score (5.2 ± 1.92 vs. 4.3 ± 1.79, p = 0.039), impaired or absent cough reflex (76.4 vs. 55.6%, p = 0.035), oropharyngeal phase dysfunction (60.6 vs. 40.8%, p = 0.047), length of hospital stay (36.0 ± 7.2 vs. 30.5 ± 11.7 days, p = 0.025) and direct medical costs (15,702.21 ± 14,244.61 vs. 10,923.99 ± 7250.14 United States dollar [USD], p = 0.042). Multivariate logistic regression showed that the total tracheostomy time (95% confidence interval [CI], 1.966−12.922, p = 0.001), impaired or absent cough reflex (95% CI, 0.084−0.695, p = 0.008), and oropharyngeal phase dysfunction (95% CI, 1.087−8.148, p = 0.034) were risk factors for pneumonia. Spearman’s correlation analysis demonstrated that PAS scores were significantly correlated with cough reflex dysfunction (r = 0.277, p = 0.03), oropharyngeal phase dysfunction (r = 0.318, p < 0.01) and total tracheostomy time (r = 0.178, p = 0.045). The oropharyngeal phase dysfunction was significantly correlated with cough reflex (r = 0.549, p < 0.001) and UES opening (r = 0.643, p < 0.01). Conclusions: Tracheostomy and dysphagia increased the risk of pneumonia in patients with stroke. Total tracheostomy time, duration of ventilator support, degree of penetration and aspiration, and oropharyngeal phase dysfunction are risk factors. Given this, we also found that there may be a correlation between tracheostomy and dysphagia.
Collapse
|
23
|
Zhang Q, Zeng R, Tang X. Application value and safety of NIPPV combined with routine clearance in the treatment of stroke-associated pneumonia in elderly patients. Am J Transl Res 2022; 14:7860-7869. [PMID: 36505335 PMCID: PMC9730089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the application value and safety of NIPPV (noninvasive positive pressure ventilation) combined with routine clearance in elderly patients with stroke-associated pneumonia (SAP). METHODS Altogether 88 elderly SAP patients treated in our hospital from January 2021 to January 2022 were retrospectively evaluated. Among them, 48 cases treated with NIPPV and routine clearance were regarded as an experimental group (EG), and 40 with routine clearance alone were enrolled to a control group (CG). The sputum clearance rate and CPIS score were compared. The safety of NIPPV was evaluated. The clearance treatment cost, hospitalization time and expenses, and the changes of inflammatory factors (IL-6, TNF-α, C-reactive protein (CRP)) were compared before and after treatment. The efficacy of airway clearance after treatment and the risk factors affecting the severity of infection was assessed. RESULTS The sputum clearance rate in the EG was higher than that in the CG (P < 0.05). After treatment, the CPIS score of EG was lower (P < 0.05). The hospitalization time and expenses of CG were higher. After treatment, the serum inflammatory factors in CG were higher (P < 0.05), while the clinical efficacy of EG was higher (P < 0.05). Treatment plan, course of disease and diabetes are risk factors for postoperative infection. CONCLUSION NIPPV combined with routine clearance is effective for elderly SAP patients, which can shorten the hospitalization time and reduce the expenses.
Collapse
|
24
|
Hasse IMC, Grosse GM, Schuppner R, Van Gemmeren T, Gabriel MM, Weissenborn K, Lichtinghagen R, Worthmann H. Circulating Inflammatory Biomarkers in Early Prediction of Stroke-Associated Infections. Int J Mol Sci 2022; 23:ijms232213747. [PMID: 36430226 PMCID: PMC9694763 DOI: 10.3390/ijms232213747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
(1) Background: Patients with acute ischaemic stroke (AIS) are at high risk for stroke-associated infections (SAIs). We hypothesised that increased concentrations of systemic inflammation markers predict SAIs and unfavourable outcomes; (2) Methods: In 223 patients with AIS, blood samples were taken at ≤24 h, 3 d and 7d after a stroke, to determine IL-6, IL-10, CRP and LBP. The outcome was assessed using the modified Rankin Scale at 90 d. Patients were thoroughly examined regarding the development of SAIs; (3) Results: 47 patients developed SAIs, including 15 lower respiratory tract infections (LRTIs). IL-6 and LBP at 24 h differed, between patients with and without SAIs (IL-6: p < 0.001; LBP: p = 0.042). However, these associations could not be confirmed after adjustment for age, white blood cell count, reduced consciousness and NIHSS. When considering the subgroup of LRTIs, in patients who presented early (≤12 h after stroke, n = 139), IL-6 was independently associated with LRTIs (OR: 1.073, 95% CI: 1.002−1.148). The ROC-analysis for prediction of LRTIs showed an AUC of 0.918 for the combination of IL-6 and clinical factors; (4) Conclusions: Blood biomarkers were not predictive for total SAIs. At early stages, IL-6 was independently associated with outcome-relevant LRTIs. Further studies need to clarify the use of biochemical markers to identify patients prone to SAIs.
Collapse
Affiliation(s)
- Isabel M. C. Hasse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Gerrit M. Grosse
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Till Van Gemmeren
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Maria M. Gabriel
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Karin Weissenborn
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-3580; Fax: +49-511-532-18625
| |
Collapse
|
25
|
Pneumonia, Aspiration Pneumonia, or Frailty-Associated Pneumonia? Geriatrics (Basel) 2022; 7:geriatrics7050115. [PMID: 36286218 PMCID: PMC9602119 DOI: 10.3390/geriatrics7050115] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Pneumonia is a common reason for admission afflicting frail older adults. Those who are the frailest are more likely to be provided with a diagnosis of aspiration pneumonia. This diagnosis has no clear definition and no clinical consensus. It is therefore time to stop attempting to differentiate between pneumonia type and use the term frailty-associated pneumonia.
Collapse
|
26
|
Predictors of pneumonia in patients with acute spontaneous intracerebral hemorrhage in Algarve, Southern Portugal. Clin Neurol Neurosurg 2022; 221:107387. [DOI: 10.1016/j.clineuro.2022.107387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/02/2022] [Accepted: 07/22/2022] [Indexed: 11/20/2022]
|
27
|
Zhong J, Liao J, Zhang R, Zhou C, Wang Z, Huang S, Huang D, Yang M, Zhang L, Ma Y, Qin X. Reduced plasma levels of RGM-A predict stroke-associated pneumonia in patients with acute ischemic stroke: A prospective clinical study. Front Neurol 2022; 13:949515. [PMID: 36188375 PMCID: PMC9523133 DOI: 10.3389/fneur.2022.949515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Stroke-induced immunodepression syndrome is considered the major etiology of stroke-associated pneumonia (SAP). Repulsive guidance molecule A (RGM-A) is an immunomodulatory protein that is closely related to inflammation and immune responses. To explore the relationship between RGM-A and SAP and facilitate the early identification of patients at high risk of developing SAP, we investigated the predictive value of RGM-A in SAP. Methods We enrolled 178 patients with acute ischemic stroke (AIS) and finally analyzed 150 patients, among whom 69 had SAP and 81 had non-SAP. During the same period, 40 patients with community-acquired pneumonia and 40 healthy participants were included as controls. SAP was defined according to the modified US Centers for Disease Control and Prevention criteria. Blood samples were collected at 24 h, 48 h, 3 days, 4 to 7 days, and 8 to 14 days after stroke onset. An enzyme-linked immunosorbent assay was used to detect the plasma levels of RGM-A and interleukin-6. Results The plasma RGM-A levels were significantly decreased in both patients with community-acquired pneumonia and those with AIS, and the decline was most pronounced in patients with SAP (P < 0.001). RGM-A started to decline within 24 h after stroke in the SAP group, and the lowest levels were detected on day 3 and days 4 to 7 (P < 0.001). The RGM-A levels in the SAP group were lower than those in the non-SAP group at all blood collection time points (P < 0.05). In the logistic regression analyses, RGM-A was a protective factor for SAP after adjusting for confounders (adjusted odds ratio = 0.22, 95% confidence interval = 0.091–0.538, P = 0.001). Receiver operating characteristic curve analysis showed that the area under the curve for RGM-A was 0.766 (0.091–0.538; P = 0.001), the cutoff value was 4.881 ng/mL, and the sensitivity and specificity were 80.00 and 76.36%, respectively. Conclusions We demonstrated that reduced plasma levels of RGM-A might help in the early identification of high-risk patients with SAP and predict the occurrence of SAP in patients with AIS. RGM-A might provide new clues to a potential alternative therapy for SAP.
Collapse
Affiliation(s)
- Jiaju Zhong
- Department of Rehabilitation Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Liao
- Department of Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Rongrong Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chanjuan Zhou
- Department of Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenyu Wang
- Department of Rehabilitation Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Siyuan Huang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Huang
- Department of Rehabilitation Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Mengliu Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Lei Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Ma
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Xinyue Qin
| |
Collapse
|
28
|
Reducing the incidence of stroke-associated pneumonia: an evidence-based practice. BMC Neurol 2022; 22:297. [PMID: 35953801 PMCID: PMC9367053 DOI: 10.1186/s12883-022-02826-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/02/2022] [Indexed: 12/27/2022] Open
Abstract
Background Pulmonary infection is a frequent complication among stroke patients and adversely affects clinical outcomes, increases the length of hospitalization stay and costs, and aggravates the financial burden of the national medical health system. Early identification and management of high-risk patients are necessary and imperative to reduce the incidence of stroke-associated pneumonia (SAP). Aim The evidence-based practice project evaluated the effectiveness of a standard care bundle intervention in preventing the occurrence of SAP. Methods The project was conducted in a neurology department of a teaching hospital. Given the variation in assessment and management standards, evidence-based practice (EBP) methodology was used to establish a process for quality improvement. A thorough literature search was conducted to identify evidence-based interventions to manage and prevent SAP. Thorough critiques of the literature and synthesis of the evidence were completed. A systematic management flow and care bundle interventions were established. The care bundle included interventions, such as the utilization of tools for SAP risk screening; dysphagia screening and rehabilitation; feeding modification, oral care, airway management, position management, and the nursing techniques of traditional Chinese medicine. Results A significant improvement was observed in preventing SAP in patients in the postimplementation group compared with those in the preimplementation group (14.0% vs. 37.2%, p = 0.025). In addition, significantly lower duration of hospitalization, lower rate of aspiration, and improvements in albumin and oral hygiene were found after the implementation of the care bundle. Conclusions Evidence-based care bundles successfully empower nurses to reduce the incidence of SAP. The management flow of SAP prevention could be promoted to other units of the neurology department in the future. The results of the project reflect positively on the capacity to implement EBP in an acute care setting for stroke. The EBP methodology can be utilized to solve other clinical problems. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02826-8.
Collapse
|
29
|
Arsava EM, Ardali Duzgun S, Durhan G, Cakan M, Akpinar E, Topcuoglu MA. Admission chest CT findings and risk assessment for stroke-associated pneumonia. Acta Neurol Belg 2022; 123:433-439. [PMID: 35879553 PMCID: PMC9312318 DOI: 10.1007/s13760-022-02043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
Abstract
Introduction Stroke-associated pneumonia (SAP) is a significant cause of morbidity and mortality after stroke. Various factors, including dysphagia and stroke severity, are closely related to SAP risk; however, the contribution of the baseline pulmonary parenchymal status to this interplay is an understudied field. Herein, we evaluated the prognostic performance of admission chest computed tomography (CT) findings in predicting SAP. Methods We evaluated admission chest CT images, acquired as part of a COVID-19-related institutional policy, in a consecutive series of acute ischemic stroke patients. The pulmonary opacity load at baseline was quantified using automated volumetry and visual scoring algorithms. The relationship between pulmonary opacities with risk of pneumonia within 7 days of symptom onset (i.e., SAP) was evaluated by bivariate and multivariate analyses. Results Twenty-three percent of patients in our cohort (n = 100) were diagnosed with SAP. Patients with SAP were more likely to have atrial fibrillation, COPD, severe neurological deficits, and dysphagia. The visual opacity score on chest CT was significantly higher among patients who developed SAP (p = 0.014), while no such relationship was observed in terms of absolute or relative opacity volume. In multivariate analyses, admission stroke severity, presence of dysphagia and a visual opacity score of ≥ 3 (OR 6.37, 95% CI 1.61–25.16; p = 0.008) remained significantly associated with SAP risk. Conclusions Pulmonary opacity burden, as evaluated on admission chest CT, is significantly associated with development of pneumonia within initial days of stroke. This association is independent of other well-known predisposing factors for SAP, including age, stroke severity, and presence of dysphagia. Supplementary Information The online version contains supplementary material available at 10.1007/s13760-022-02043-7.
Collapse
Affiliation(s)
- Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
| | - Selin Ardali Duzgun
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gamze Durhan
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Melike Cakan
- Department of Neurology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Erhan Akpinar
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Akif Topcuoglu
- Department of Neurology, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| |
Collapse
|
30
|
Huang L, Zhang R, Ji J, Long F, Wang Y, Lu J, Xu G, Sun Y. Hypersensitive C-reactive protein-albumin ratio is associated with stroke-associated pneumonia and early clinical outcomes in patients with acute ischemic stroke. Brain Behav 2022; 12:e2675. [PMID: 35748095 PMCID: PMC9304827 DOI: 10.1002/brb3.2675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES We aimed to explore the association between the baseline hypersensitive C-reactive protein-albumin ratio (CAR) and stroke-associated pneumonia (SAP) during hospitalization and the short-term prognosis in patients with acute ischemic stroke (AIS). METHODS We enrolled 766 patients with AIS and collected their admission baseline characteristics, including their National Institutes of Health Stroke Scale score, CAR, age, atrial fibrillation, dysphagia, sex, stroke severity (A2 DS2 ) score, and other information. The occurrence of SAP within 7 days after stroke, length of hospital stay, and physical condition at discharge were also recorded. The patients' Modified Rankin Scale (mRS) scores and mortality 3 months after AIS were further evaluated at follow-up. All patients were divided into four groups based on the quartiles of the admission CAR (Q1 <1.3, Q2 1.3-3.7, Q3 3.7-9.3, Q4 ≥9.3). RESULTS During hospitalization, 92 (11.9%) patients were diagnosed with SAP. The patients with SAP had a higher CAR than the non-SAP patients (p < .001). In the multivariate-adjusted model, the patients in the Q3 and Q4 groups had a higher SAP risk (aOR was 5.21 and 17.72, p-trend < .001) than those in the lowest quartile. The area under the curve for the CAR's ability to predict SAP was 0.810 in the receiver operating characteristic curve analysis and had a similar predictive efficacy as the A2 DS2 score (p <.05). The length of stay in the SAP group was almost the same as that in the non-SAP group, but the clinical outcomes were worse at discharge and at the 3-month follow-up in the SAP group. In addition, the patients in the higher CAR quartiles at admission were more likely to have poorer clinical outcomes. CONCLUSIONS Patients with AIS with a high CAR at admission are more likely to develop SAP during hospitalization and have poor short-term clinical outcomes. These findings might help to timely identify patients at high risk of SAP and provide a basis for further research on prophylactic antibiotic therapy.
Collapse
Affiliation(s)
- Lingling Huang
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Rong Zhang
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Jiahui Ji
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Fengdan Long
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Yadong Wang
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Juan Lu
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Ge Xu
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Yaming Sun
- Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| |
Collapse
|
31
|
Xu Y, Qiao H, Yang S, Zhou L, Zhao Y, Xu Q, Miao S, Yuan D, Zhao J, Liu Y. 15-Hydroxyprostaglandin Dehydrogenase Is a Predictor of Stroke-Associated Pneumonia. Front Neurol 2022; 13:893624. [PMID: 35720081 PMCID: PMC9202497 DOI: 10.3389/fneur.2022.893624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/27/2022] [Indexed: 12/25/2022] Open
Abstract
Background and Purpose Stroke is a serious fatal and disabling disease. Stroke-associated pneumonia (SAP) is the most common complication of stroke, which may further aggravate the stroke. The prevention and early prediction of SAP is a key clinical strategy. 15-hydroxyprostaglandin dehydrogenase (15-PGDH) is involved in pneumonia, while its relationship with SAP has yet to be determined. Therefore, we investigated the predictive value of 15-PGDH for SAP and visualized their relationship. Methods Stroke patients were recruited and divided into SAP group and Non-SAP group. Baseline demographic and clinical data were obtained from the medical record system, blood samples were collected to detect relevant variables and 15-PGDH levels. Patient characteristics were compared with a t-test. Binary logistic regression analysis was performed to determine the predictive value of 15-PGDH for SAP. Restricted cubic splines (RCS) were performed to visualize the relationship between 15-PGDH and SAP risk. Finally, the SAP patient characteristics between the severe group and mild group were compared. Results 50 patients were enrolled and divided into SAP group (n = 26) and Non-SAP group (n = 24). 15-PGDH in the SAP group was lower than that in the Non-SAP group (0.258 ± 0.275 vs. 0.784 ± 0.615, p = 0.025). Binary logistic regression analysis revealed that the lower 15-PGDH, the higher the risk of SAP (OR = 0.04, 95%CI, 0.010–0.157, p < 0.001). The RCS model showed the L-shaped relationship between 15-PGDH and SAP. Conclusions In stroke patients, serum 15-PGDH is a valuable biomarker for predicting SAP. There is an L-shaped relationship between the level of 15-PGDH and the risk of SAP.
Collapse
Affiliation(s)
- Yunfei Xu
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China.,Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Haoduo Qiao
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China.,Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Shun Yang
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Lin Zhou
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China.,Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Yao Zhao
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China.,Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Qing Xu
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China.,Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| | - Shuying Miao
- China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China.,Department of Pathology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Dun Yuan
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Jie Zhao
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China
| | - Ying Liu
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, Changsha, China.,Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.,Sepsis Translational Medicine Key Lab of Hunan Province, Central South University, Changsha, China.,China-Africa Research Center of Infectious Diseases, Central South University, Changsha, China
| |
Collapse
|
32
|
Yamauchi K, Kumagae K, Goto K, Harayama E, Tanaka S, Hagiwara R, Uchida Y, Kuroyama S, Koyanagi Y, Arakawa S. Ambulation status at an acute care hospital predicts pneumonia and mortality in stroke patients: A retrospective cohort study. Geriatr Gerontol Int 2022; 22:554-559. [PMID: 35706408 DOI: 10.1111/ggi.14411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
AIM Higher post-stroke functional performance is associated with lower mortality in patients with stroke. This study aimed to investigate the relationship between ambulation ability in the acute phase of stroke, and pneumonia and mortality 1 year after stroke onset. METHODS This retrospective cohort study included consecutive stroke patients between April 2008 and December 2018. Patients were divided into six groups according to their Functional Ambulation Category score at discharge (0 [unable to walk] to 5 [able to walk independently]). We observed pneumonia cases and all-cause mortality over 1 year, and investigated the association between Functional Ambulation Category score and pneumonia or mortality. Survival analysis was carried out using Kaplan-Meier curves, log-rank tests and Cox regression models. RESULTS We analyzed 1727 consecutive patients (median age 77 years; 54% men). During the observation period, 144 patients (8.3%) experienced pneumonia and 157 (9.1%) died. Increasing ambulatory impairment showed stepwise relationships with the risk of pneumonia and mortality. Compared with patients with a Functional Ambulation Category score of 5, those with scores of 4 and 3 showed no significant association with pneumonia risk; a score ≤2 was significantly different. There was a stepwise relationship between increased gait disturbance and risk of death compared with the Functional Ambulation Category 5 group. CONCLUSIONS Ambulation ability at discharge from an acute hospital is an important predictor of pneumonia incidence and survival in stroke patients at 1 year; these associations were observed even after controlling for clinical parameters, such as stroke severity and comorbidity. Geriatr Gerontol Int 2022; ••: ••-••.
Collapse
Affiliation(s)
- Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Kenichi Kumagae
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Kei Goto
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Eisei Harayama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shota Tanaka
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Risa Hagiwara
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yoshiko Uchida
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Sota Kuroyama
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yasuhiro Koyanagi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| |
Collapse
|
33
|
Yang L, Wenping X, Jinfeng Z, Jiangxia P, Jingbo W, Baojun W. Are beta blockers effective in preventing stroke associated infections? - a systematic review and meta-analysis. Aging (Albany NY) 2022; 14:4459-4470. [PMID: 35585021 PMCID: PMC9186777 DOI: 10.18632/aging.204086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Excessive sympathoexcitation could lead to stroke associated infection. Inhibiting sympathetic excitation may reduce the infection risk after stroke. Thus, the present study aimed to determine the protective effect of beta blockers on stroke associated infection through systematic review and meta-analysis. METHODS A systematic search of multiple databases were performed up to February 2022. The included studies required beta blockers therapy in stroke patients and assessed the incidence of stroke-associated infections. Outcomes of interest included infections, pneumonia, urinary tract infection and sepsis. Random-effects model was used for analysis. Heterogeneity was evaluated using I2 statistics and publication bias was evaluated by the funnel plot. RESULT A total of 83 potentially relevant publications was identified in the initial search. Six studies met the inclusion criteria for meta-analysis. The risk of bias in the included articles satisfies the quality requirement of meta-analysis. No significant associations between beta blockers therapy and the prevention of stroke associated infection, stroke associated pneumonia and septicemia were found, However, subgroup analyses revealed an association between beta blockers treatment and the increased risk of post-stroke urinary tract infection or stroke associated pneumonia in some stroke patients (OR = 1.69 [1.33, 2.14], P < 0.0001; OR = 1.85 [1.51, 2.26], P < 0.0001). CONCLUSION Due to the lack of robust evidence, this meta-analysis may not support the preventive effect of beta blockers on stroke associated infection. But beta blockers treatment may be associated with development of post-stroke urinary tract infection and stroke associated pneumonia in some stroke patients.
Collapse
Affiliation(s)
- Li Yang
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China.,School of Medicine, Inner Mongolia Medical University, Inner Mongolia, Hohhot, China
| | - Xiang Wenping
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| | - Zhang Jinfeng
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| | - Pang Jiangxia
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| | - Wang Jingbo
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| | - Wang Baojun
- Department of Neurology, Baotou Center Hospital, Inner Mongolia, Baotou, China
| |
Collapse
|
34
|
Banda KJ, Chu H, Kang XL, Liu D, Pien LC, Jen HJ, Hsiao STS, Chou KR. Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis. BMC Geriatr 2022; 22:420. [PMID: 35562660 PMCID: PMC9103417 DOI: 10.1186/s12877-022-02960-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 03/04/2022] [Indexed: 12/30/2022] Open
Abstract
Background Post-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke. Methods Our search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD. Results The pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13–7.79) and mortality 4.07 (95% CI, 2.17–7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13–2.07), previous stroke 1.40 (95% CI, 1.18–1.67), severe stroke 1.38 (95% CI, 1.17–1.61), females 1.25 (95% CI, 1.09–1.43), and diabetes mellitus 1.24 (95% CI, 1.02–1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70–0.95) and ischaemic stroke 0.54 (95% CI, 0.46–0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis. Conclusions Assessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate. Trial registration https://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb. Supplementary information The online version contains supplementary material available at 10.1186/s12877-022-02960-5.
Collapse
Affiliation(s)
- Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ju Jen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Shu-Tai Shen Hsiao
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan. .,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. .,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan. .,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. .,Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
35
|
Endres M, Moro MA, Nolte CH, Dames C, Buckwalter MS, Meisel A. Immune Pathways in Etiology, Acute Phase, and Chronic Sequelae of Ischemic Stroke. Circ Res 2022; 130:1167-1186. [PMID: 35420915 DOI: 10.1161/circresaha.121.319994] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Inflammation and immune mechanisms are crucially involved in the pathophysiology of the development, acute damage cascades, and chronic course after ischemic stroke. Atherosclerosis is an inflammatory disease, and, in addition to classical risk factors, maladaptive immune mechanisms lead to an increased risk of stroke. Accordingly, individuals with signs of inflammation or corresponding biomarkers have an increased risk of stroke. Anti-inflammatory drugs, such as IL (interleukin)-1β blockers, methotrexate, or colchicine, represent attractive treatment strategies to prevent vascular events and stroke. Lately, the COVID-19 pandemic shows a clear association between SARS-CoV2 infections and increased risk of cerebrovascular events. Furthermore, mechanisms of both innate and adaptive immune systems influence cerebral damage cascades after ischemic stroke. Neutrophils, monocytes, and microglia, as well as T and B lymphocytes each play complex interdependent roles that synergize to remove dead tissue but also can cause bystander injury to intact brain cells and generate maladaptive chronic inflammation. Chronic systemic inflammation and comorbid infections may unfavorably influence both outcome after stroke and recurrence risk for further stroke. In addition, stroke triggers specific immune depression, which in turn can promote infections. Recent research is now increasingly addressing the question of the extent to which immune mechanisms may influence long-term outcome after stroke and, in particular, cause specific complications such as poststroke dementia or even poststroke depression.
Collapse
Affiliation(s)
- Matthias Endres
- Klinik für Neurologie mit Experimenteller Neurologie (M.E., C.H.N., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Center for Stroke Research Berlin (M.E., C.H.N., C.D., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Excellence Cluster NeuroCure (M.E.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,German Center for Neurodegenerative Diseases, Partner Site Berlin, Germany (M.E.).,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (M.E., C.H.N.)
| | - Maria A Moro
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (M.A.M.).,Departamento de Farmacología yToxicología, Unidad de Investigación Neurovascular, Universidad Complutense de Madrid, Madrid, Spain (M.A.M.).,Instituto Universitario de Investigación en Neuroquímica, UCM, Madrid, Spain (M.A.M.).,Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain (M.A.M.)
| | - Christian H Nolte
- Klinik für Neurologie mit Experimenteller Neurologie (M.E., C.H.N., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Center for Stroke Research Berlin (M.E., C.H.N., C.D., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (M.E., C.H.N.)
| | - Claudia Dames
- Center for Stroke Research Berlin (M.E., C.H.N., C.D., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Institute for Medical Immunology (C.D.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Marion S Buckwalter
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (M.S.B.).,Wu Tsai Neurosciences Institute, Stanford University, CA (M.S.B.)
| | - Andreas Meisel
- Klinik für Neurologie mit Experimenteller Neurologie (M.E., C.H.N., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Center for Stroke Research Berlin (M.E., C.H.N., C.D., A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,NeuroCure Clinical Research Center (A.M.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| |
Collapse
|
36
|
Pekacka-Egli AM, Herrmann J, Spielmanns M, Goerg A, Schulz K, Zenker E, Windisch W, Kulnik ST. Inhalation Therapy with Nebulized Capsaicin in a Patient with Oropharyngeal Dysphagia Post Stroke: A Clinical Case Report. Geriatrics (Basel) 2022; 7:geriatrics7020027. [PMID: 35314599 PMCID: PMC8938770 DOI: 10.3390/geriatrics7020027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/04/2022] Open
Abstract
Dysphagia and aspiration risk are common sequelae of stroke, leading to increased risk of stroke-associated pneumonia. This is often aggravated by stroke-related impairment of cough, the most immediate mechanical defense mechanism against aspiration. In humans, reflex cough can be repeatedly and safely elicited by inhalation of nebulized capsaicin, a compound contained in chili peppers. Could this cough-eliciting property of capsaicin support the recovery of stroke survivors who present with dysphagia and aspiration risk? We present a clinical case report of a 73-year-old man, admitted to inpatient stroke rehabilitation following a right middle cerebral artery infarct with subsequent dysphagia and hospital-acquired pneumonia. A course of daily inhalation therapy with nebulized capsaicin was initiated, triggering reflex coughs to support secretion clearance and prevent recurrence of pneumonia. Clinical observations in each inhalation therapy session demonstrate good patient response, safety and tolerability of nebulized capsaicin in this mode of application. Repeated Fiberoptic Endoscopic Evaluation of Swallowing (FEES) assessments show concurrent improvement in the patient’s swallowing status. Inhalation therapy with nebulized capsaicin may offer a viable treatment to facilitate coughing and clearing of secretions, and to minimize aspiration and risk of aspiration-related pneumonia post stroke. Further investigation in a randomized controlled trial design is warranted.
Collapse
Affiliation(s)
- Anna Maria Pekacka-Egli
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
- Correspondence: ; Tel.: +41-55-256-69-70
| | - Jana Herrmann
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
| | - Marc Spielmanns
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
| | - Arthur Goerg
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
| | - Katharina Schulz
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
| | - Eveline Zenker
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland; (J.H.); (M.S.); (A.G.); (K.S.); (E.Z.)
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
| | - Wolfram Windisch
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St. George’s University of London, London SW17 0RE, UK;
| |
Collapse
|
37
|
Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials. J Clin Med 2022; 11:jcm11030685. [PMID: 35160137 PMCID: PMC8836405 DOI: 10.3390/jcm11030685] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/16/2022] [Accepted: 01/23/2022] [Indexed: 02/05/2023] Open
Abstract
Objective: To determine the effects of behavioural interventions in people with oropharyngeal dysphagia. Methods: Systematic literature searches were conducted to retrieve randomized controlled trials in four different databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of eligible articles was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), after which meta-analyses were performed using a random-effects model. Results: A total of 37 studies were included. Overall, a significant, large pre-post interventions effect size was found. To compare different types of interventions, all behavioural interventions and conventional dysphagia treatment comparison groups were categorised into compensatory, rehabilitative, and combined compensatory and rehabilitative interventions. Overall, significant treatment effects were identified favouring behavioural interventions. In particular, large effect sizes were found when comparing rehabilitative interventions with no dysphagia treatment, and combined interventions with compensatory conventional dysphagia treatment. When comparing selected interventions versus conventional dysphagia treatment, significant, large effect sizes were found in favour of Shaker exercise, chin tuck against resistance exercise, and expiratory muscle strength training. Conclusions: Behavioural interventions show promising effects in people with oropharyngeal dysphagia. However, due to high heterogeneity between studies, generalisations of meta-analyses need to be interpreted with care.
Collapse
|
38
|
Won SY, Krieger S, Dubinski D, Gessler F, Behmanesh B, Freiman TM, Konczalla J, Seifert V, Lapa S. Neurogenic Dysphagia in Subdural Hematoma. Front Neurol 2022; 12:701378. [PMID: 35153966 PMCID: PMC8826688 DOI: 10.3389/fneur.2021.701378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Dysphagia is a common and severe symptom of traumatic brain injury (TBI) affecting up to 78% of patients. It is associated with pneumonia, increased morbidity, and mortality. Although subdural hematoma (SDH) accounts for over 50% of TBI, the occurrence of dysphagia in this subtype has not been investigated yet. Methods All patients with SDH admitted to the author's institution between the years 2007 and 2020 were included in the study. Patients with SDH and clinical suspicion for dysphagia received a clinical swallowing assessment by a speech and language pathologist (SLP). Furthermore, the severity of dysphagia was rated according to swallowing disorder scale. Functional outcome was evaluated by the Glasgow outcome scale (GOS). Results Out of 545 patients with SDH, 71 patients had dysphagia (13%). The prevalence of dysphagia was significantly lower in the surgical arm compared to the conservative arm (11.8 vs. 21.8%; OR 0.23; p = 0.02). Independent predictors for dysphagia were GCS <13 at admission (OR 4.17; p < 0.001), cardiovascular disease (OR 2.29; p = 0.002), and pneumonia (OR 2.88; p = 0.002), whereas the operation was a protective factor (OR 0.2; p < 0.001). In a subgroup analysis, right-sided SDH was an additional predictor for dysphagia (OR 2.7; p < 0.001). Overall, patients with dysphagia improved significantly under the SLP treatment from the initial diagnosis to hospital discharge (p < 0.01). However, a subgroup of patients with the most severe grade of dysphagia showed no significant improvement. Patients with dysphagia had significantly worse outcomes (GOS 1–3) compared to those without dysphagia (48.8 vs. 26.4%; p < 0.001). Conclusion Dysphagia is a frequent symptom in SDH, and the early identification of dysphagia is crucial regarding the initiation of treatment and functional outcome. Surgery is effective in preventing dysphagia and should be considered in high-risked patients.
Collapse
Affiliation(s)
- Sae-Yeon Won
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
- *Correspondence: Sae-Yeon Won
| | - Simon Krieger
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Thomas M. Freiman
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Juergen Konczalla
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany
| | - Sriramya Lapa
- Department of Neurology, University Hospital, Goethe University, Frankfurt, Germany
| |
Collapse
|
39
|
Oliveira I, Couto G, Santos R, Campolargo A, Lima C, Ferreira P. Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [DOI: 10.1159/000520505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts’ consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.
Collapse
|
40
|
Accuracy of Acoustic Evaluation of Swallowing as a Diagnostic Method of Dysphagia in Individuals Affected by Stroke: Preliminary Analysis. Dysphagia 2021; 37:724-735. [PMID: 34586494 DOI: 10.1007/s00455-021-10358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
After a stroke, more than half of the patients have some kind of disability, and dysphagia is frequently found. Cervical auscultation by Doppler sonar is an innovative technique with gain of credibility in the clinical evaluation of swallowing. To verify the diagnostic accuracy of Doppler sonar along with the DeglutiSom® software as an auxiliary method in the evaluation of oropharyngeal dysphagia in patients after stroke. The research is a cross-sectional, uncontrolled, blind, quantitative study with systematic random sampling. Patients from inpatient and outpatient units of a reference hospital with a stroke care unit were concomitantly submitted to both Doppler sonar and Fiberoptic Endoscopic Evaluation of Swallowing (FEES®). Seventy-three audio files collected from 26 patients through Doppler sonar were analyzed using DeglutiSom® software and confronted with the FEES® report, regarding three food consistencies offered to them during the exam. The study showed that the Doppler sonar correctly identified, among all the analyzed files, those that actually presented tracheal aspiration as well as it effectively identified patients who did not aspirate. The Youden index of 0.91 corroborates this information, showing a promising accuracy in detecting tracheal aspiration in the studied sample. The study evaluates the diagnostic accuracy of Doppler sonar, showing that it can be used as a valuable tool in the diagnosis of tracheal aspiration in patients after stroke. It is important to emphasize that the identification of residue by this method requires further studies. Also, larger sample size and more than one blind evaluator should be considered in future researches to increase the reliability of the proposed method.
Collapse
|
41
|
Chen Y, Yang H, Wei H, Chen Y, Lan M. Stroke-associated pneumonia: A bibliometric analysis of worldwide trends from 2003 to 2020. Medicine (Baltimore) 2021; 100:e27321. [PMID: 34559149 PMCID: PMC8462563 DOI: 10.1097/md.0000000000027321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/03/2021] [Indexed: 01/05/2023] Open
Abstract
Stroke-associated pneumonia (SAP) is a spectrum of pulmonary infections in patients within 7 days of stroke. Which is one of the most common complications after stroke and is significantly associated with a poor prognosis of stroke. To the best of our knowledge, a bibliometric method was not previously used to analyze the topic of SAP; we aim to describe the situation and evolution of SAP from 2003 to 2020, and to discuss the research hotspots and frontiers.A total of 151 articles were retrieved from the Scopus database. Bibliometric analysis was used to explore the dynamic trends of articles and the top subject areas, journals, institutes, citations, and co-keywords. VOS viewer software (version 1.6.15) was used to graphically map the hot topics of SAP based on the co-keywords.A total of 151 articles were identified. Articles have increased over the recent years and faster in the last 2 years (55 articles, 36.4%), the majority of subject areas are medicine (124 articles, 82.1%) and neuroscience (38 articles, 25.2%). The "Journal Of Stroke And Cerebrovascular Diseases" with 15 articles has been scored as the first rank followed by "Plos One." Regarding the geographical distribution of articles, China is the most productive country with 50 articles (33.1%), others are more prominent in Europe, and most institutes are universities. Citations have increased over time, the main country of the top five highly cited published articles are Germany and before 2008. The co-keywords are mainly divided into four aspects: risk factors, predictive scores, preventions, and outcomes.This study could provide practical sources for researchers to find the top subject areas, journals, institutes, citations, and co-keywords. Moreover, the study could pave the way for researchers to be engaged in studies potentially lead to more articles in this field.
Collapse
Affiliation(s)
- Yuanyuan Chen
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyan Yang
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Wei
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yanqin Chen
- Neurology Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Meijuan Lan
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
42
|
Benfield JK, Wilkinson G, Everton LF, Bath PM, England TJ. Diagnostic accuracy of the Dysphagia Trained Nurse Assessment tool in acute stroke. Eur J Neurol 2021; 28:2766-2774. [PMID: 33960075 DOI: 10.1111/ene.14900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Comprehensive swallow screening assessments to identify dysphagia and make early eating and drinking recommendations can be used by trained nurses. This study aimed to validate the Dysphagia Trained Nurse Assessment (DTNAx) tool in acute stroke patients. METHODS Participants with diagnosed stroke were prospectively and consecutively recruited from an acute stroke unit. Following a baseline DTNAx on admission, participants underwent a speech and language therapist (SLT) bedside assessment of swallowing (speech and language therapist assessment [SLTAx]), videofluoroscopy (VFS) and a further DTNAx by the same or a different nurse. RESULTS Forty-seven participants were recruited, of whom 22 had dysphagia. Compared to SLTAx in the identification of dysphagia, DTNAx had a sensitivity of 96.9% (95% confidence interval [CI] 83.8-99.9) and specificity of 89.5% (95% CI 75.2-97.1). Compared to VFS in the identification of aspiration, DTNAx had a sensitivity of 77.8% (95% CI 40.0-97.2) and a specificity of 81.6% (95% CI 65.7-92.3). Over 81% of the diet and fluid recommendations made by the dysphagia trained nurses were in absolute agreement compared to SLTAx. Both DTNAx and SLTAx had low diagnostic accuracy compared to the VFS-based definition of dysphagia. CONCLUSIONS Nurses trained in DTNAx showed good diagnostic accuracy in identifying dysphagia compared to SLTAx and in identifying aspiration compared to VFS. They made appropriate diet and fluid recommendations in line with SLTs in the early management of dysphagia.
Collapse
Affiliation(s)
- Jacqueline K Benfield
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK.,Derbyshire Community Health Services NHS Trust, Derby, UK
| | - Gwenllian Wilkinson
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
| | - Lisa F Everton
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK.,Department of Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| |
Collapse
|
43
|
Wattoo MA, Tabassum M, Bhutta KR, Rafi Z, Kaneez M, Razzaq MT, Rizwan R, Sarwar Z, Sajid MU, Bhutta FR. Clinical and Microbiological Analysis of Hospital-Acquired Pneumonia Among Patients With Ischemic Stroke: A Retrospective Outlook. Cureus 2021; 13:e15214. [PMID: 34178533 PMCID: PMC8221085 DOI: 10.7759/cureus.15214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Hospital-acquired pneumonia (HAP) is a leading cause of morbidity and mortality in patients with ischemic stroke. Our study aims to explore the clinical and microbiological aspects (culture and sensitivity) of stroke patients with a confirmed diagnosis of HAP. Methodology This retrospective cross-sectional study included a total of 232 patients with a confirmed diagnosis of HAP following ischemic stroke. HAP was diagnosed based on the timing of onset of symptoms and chest X-ray. Patients were evaluated for their demographic details and a myriad of clinical parameters including dysphagia, mechanical ventilation, mortality, spontaneous pneumothorax, and Glasgow coma scale (GCS) score. The frequencies of different microorganisms isolated from the tracheal secretions were reported. Thereafter, the percentages of resistant isolates against a plethora of antimicrobial agents were tabulated. Results Out of 232 patients, 110 were males and 122 were females with a mean age of 58.79 ± 8.62 years. Dysphagia and mechanical ventilation were present in 66.4% and 72%, respectively. The mortality rate was 30.6%. Klebsiella pneumoniae was the most frequently isolated organism (28.9%), followed by Escherichia coli (24.5%), and Pseudomonas aeruginosa (23.3%). The antimicrobial resistance patterns of most of the isolates against different antibiotics were alarmingly high. Conclusions Dysphagia and mechanical ventilation are frequently present in patients of ischemic stroke with associated HAP. The antimicrobial resistance patterns of the isolated organisms are a cause of major concern. This necessitates the need for proper sanitation and the careful use of antibiotics.
Collapse
Affiliation(s)
| | | | - Kiran R Bhutta
- Internal Medicine, Islam Medical and Dental College, Sialkot, PAK
| | - Zainab Rafi
- Neurology, Sialkot Medical College, Sialkot, PAK
| | - Mehwish Kaneez
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Rafay Rizwan
- Internal Medicine, Rashid Latif Medical College, Lahore, PAK
| | - Zoya Sarwar
- Internal Medicine, Rashid Latif Medical College, Lahore, PAK
| | | | | |
Collapse
|
44
|
Procalcitonin related to stroke-associated pneumonia and clinical outcomes of acute ischemic stroke after IV rt-PA treatment. Cell Mol Neurobiol 2021; 42:1419-1427. [PMID: 33389464 DOI: 10.1007/s10571-020-01031-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/15/2020] [Indexed: 12/28/2022]
Abstract
To investigate the possible relationship between procalcitonin (PCT) and stroke-associated pneumonia (SAP) as well as clinical outcomes after recombinant tissue plasminogen activator (rt-PA) treatment of AIS. From June 2015 to December 2019, 173 consecutive patients with AIS after IV rt-PA treatment were prospectively enrolled. Serum PCT concentrations were measured after admission. Multivariate logistic regression analysis was used to examine the potential risk factors of SAP, poor outcome and mortality. Of the 173 patients, 49 (28.3%) participants were identified with SAP, 87 (50.3%) with poor outcome, and 28 (16.2%) with mortality. Multivariate logistic regression analysis demonstrated that patients with PCT in the second [odds ratio (OR) 4.413; 95% confidence interval (CI) 1.331-14.634; P = 0.015] and third tertile (OR 10.958; 95% CI 3.524-34.071; P < 0.001) were more likely to have SAP compared with the first tertile. Besides, PCT was an independent predictor of 3-month poor outcome (OR 3.219, 95% CI 1.291-8.028, P = 0.007) and mortality (OR 7.538, 95% CI 2.061-27.564, P = 0.002). In receiver operating characteristic (ROC) curve analysis, the diagnostic and prognostic accuracy of PCT was higher than hs-CRP. This study demonstrated that PCT was a reliable diagnostic and prognostic biomarker of SAP and poor clinical outcomes in Chinese AIS patients after IV rt-PA treatment.
Collapse
|
45
|
Borglin G, Eriksson M, Rosén M, Axelsson M. Registered nurses' experiences of providing respiratory care in relation to hospital- acquired pneumonia at in-patient stroke units: a qualitative descriptive study. BMC Nurs 2020; 19:124. [PMID: 33342427 PMCID: PMC7750009 DOI: 10.1186/s12912-020-00518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to describe registered nurses’ (RNs) experiences of providing respiratory care in relation to hospital acquired pneumonia (HAP), specifically among patients with acute stroke being cared for at in-patient stroke units. Background One of the most common and serious respiratory complications associated with acute stroke is HAP. Respiratory care is among the fundamentals of patient care, and thus competency in this field is expected as part of nursing training. However, there is a paucity of literature detailing RNs’ experiences with respiratory care in relation to HAP, specifically among patients with acute stroke, in the context of stroke units. As such, there is a need to expand the knowledge base relating to respiratory care focusing on HAP, to assist with evidence-based nursing. Design A qualitative descriptive study. Method Eleven RNs working in four different acute stroke units in Southern Sweden participated in the current study. The data were collected through semi-structured interviews, and the transcribed interviews were analysed using inductive content analysis. Results Three overarching categories were identified: (1), awareness of risk assessments and risk factors for HAP (2) targeting HAP through multiple nursing care actions, and (3) challenges in providing respiratory care to patients in risk of HAP. These reflected the similarities and differences in the experiences that RNs had with providing respiratory care in relation to HAP among in-patients with acute stroke. Conclusions The findings from this study suggest that the RNs experience organisational challenges in providing respiratory care for HAP among patients with acute stroke. Respiratory care plays a vital role in the identification and prevention of HAP, but our findings imply that RNs’ knowledge needs to be improved, the fundamentals of nursing care need to be prioritised, and evidence-based guidelines must be implemented. RNs would also benefit from further education and support, in order to lead point-of-care nursing in multidisciplinary stroke teams.
Collapse
Affiliation(s)
- Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06, Malmö, Sweden. .,Department of Nursing Education, Lovisenberg Diaconal University College, 0456, Oslo, Norway.
| | - Miia Eriksson
- Department of Neurology, Skåne University Hospital, SE-222 42, Malmö, Sweden
| | - Madeleine Rosén
- Department of Neurology, Skåne University Hospital, SE-222 42, Malmö, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06, Malmö, Sweden
| |
Collapse
|
46
|
Pilato F, Silva S, Valente I, Distefano M, Broccolini A, Brunetti V, Caliandro P, Marca GD, Di Iorio R, Frisullo G, Monforte M, Morosetti R, Piano C, Calandrelli R, Capone F, Alexandre A, Pedicelli A, Colosimo C, Caricato A. Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit-A Prospective Cohort Study. Brain Sci 2020; 10:brainsci10120911. [PMID: 33256264 PMCID: PMC7761293 DOI: 10.3390/brainsci10120911] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023] Open
Abstract
Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20–11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04–10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61–0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92–0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11–0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65–37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency.
Collapse
Affiliation(s)
- Fabio Pilato
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
- Correspondence: ; Tel.: +39-06-30151
| | - Serena Silva
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
| | - Iacopo Valente
- UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (I.V.); (R.C.); (A.A.); (A.P.); (C.C.)
| | - Marisa Distefano
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Aldobrando Broccolini
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Valerio Brunetti
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Pietro Caliandro
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Giacomo Della Marca
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Riccardo Di Iorio
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Giovanni Frisullo
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Mauro Monforte
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Roberta Morosetti
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Carla Piano
- UOC Neurologia, Dipartimento Scienze dell’invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.B.); (V.B.); (P.C.); (G.D.M.); (R.D.I.); (G.F.); (M.M.); (R.M.); (C.P.)
| | - Rosalinda Calandrelli
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Department of Medicine, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Andrea Alexandre
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
| | - Alessandro Pedicelli
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
| | - Cesare Colosimo
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Anselmo Caricato
- UOC Anestesia Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento Scienze dell’Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.S.); (A.C.)
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
| |
Collapse
|
47
|
Jones CA, Colletti CM, Ding MC. Post-stroke Dysphagia: Recent Insights and Unanswered Questions. Curr Neurol Neurosci Rep 2020; 20:61. [PMID: 33136216 PMCID: PMC7604228 DOI: 10.1007/s11910-020-01081-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? RECENT FINDINGS There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.
Collapse
Affiliation(s)
- Corinne A Jones
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA. .,Speech, Language, & Hearing Sciences; Moody College of Communication, The University of Texas, Austin, TX, USA.
| | - Christina M Colletti
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| | - Ming-Chieh Ding
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| |
Collapse
|
48
|
Eltringham SA, Pownall S, Bray B, Smith CJ, Piercy L, Sage K. Experiences of Dysphagia after Stroke: An Interview Study of Stroke Survivors and Their Informal Caregivers. Geriatrics (Basel) 2019; 4:geriatrics4040067. [PMID: 31817883 PMCID: PMC6960615 DOI: 10.3390/geriatrics4040067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 12/05/2022] Open
Abstract
(1) Background: Swallowing difficulties (dysphagia) after stroke are not uncommon and is a consistent risk factor for stroke-associated pneumonia. This interview study explores the perspectives of stroke survivors, who had their swallowing assessed in the first few days of admission to hospital, and their informal caregivers. (2) Methods: A participatory approach was used involving people affected by stroke in the interpretation and analysis of the interview data. Data was thematically analysed and six themes were identified. (3) Results: These themes included how past-future experiences may influence a person’s emotional response to events; understanding what is happening and adjustment; the impact of dysphagia; attitudes to care; communication to patients and procedural issues. (4) Conclusion: The findings highlight the importance of effective public health messages to improve people’s responsiveness to the signs of stroke, standardisation of assessment and management procedures, effective communication to patients about the consequences of dysphagia, and the impact of dysphagia on the person who had the stroke and their informal caregiver.
Collapse
Affiliation(s)
- Sabrina A. Eltringham
- Sheffield Teaching Hospitals NHS Foundation Trust, Speech and Language Therapy Department, SheffieldS10 2JF, UK
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
- Correspondence:
| | - Sue Pownall
- Sheffield Teaching Hospitals NHS Foundation Trust, Speech and Language Therapy Department, SheffieldS10 2JF, UK
| | - Ben Bray
- School of Population Health and Environmental Sciences, King’s College London, London SE1 1UL, UK
| | - Craig J. Smith
- Division of Cardiovascular Sciences, University of Manchester, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford M6 8HD, UK
| | | | - Karen Sage
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK
| |
Collapse
|
49
|
Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study. Geriatrics (Basel) 2019; 4:geriatrics4040060. [PMID: 31731452 PMCID: PMC6960646 DOI: 10.3390/geriatrics4040060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Patients with dysphagia are at increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed. The aim of this study is to explore staff opinions about current practice of dysphagia screening, assessment and clinical management in acute phase stroke. (2) Methods: Fifteen interviews were conducted in five English National Health Service hospitals. Hospitals were selected based on size and performance against national targets for dysphagia screening and assessment, and prevalence of stroke-associated pneumonia. Participants were purposefully recruited to reflect a range of healthcare professions. Data were analysed using a six-stage thematic process. (3) Results: Three meta themes were identified: delays in care, lack of standardisation and variability in resources. Patient, staff, and service factors that contribute to delays in dysphagia screening, assessment by a speech and language therapist, and delays in nasogastric tube feeding were identified. These included admission route, perceived lack of ownership for screening patients, prioritisation of assessments and staff resources. There was a lack of standardisation of dysphagia screening protocols and oral care. There was variability in staff competences and resources to assess patients, types of medical interventions, and care processes. (4) Conclusion: There is a lack of standardisation in the way patients are assessed for dysphagia and variation in practice relating to staff competences, resources and care processes between hospitals. A range of patient, staff and service factors have the potential to impact on stroke patients being assessed within the recommended national guidelines.
Collapse
|
50
|
Wang YJ, Chen YG, Lv CZ, Zhao XQ, Guo W. An updated Chinese consensus statement on stroke-associated pneumonia 2019. ASIAN PAC J TROP MED 2019. [DOI: 10.4103/1995-7645.271937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|