1
|
Guo R, Yan S, Li Y, Liu K, Wu F, Feng T, Chen R, Liu Y, You C, Tian R. A Novel Machine Learning Model for Predicting Stroke-Associated Pneumonia After Spontaneous Intracerebral Hemorrhage. World Neurosurg 2024; 189:e141-e152. [PMID: 38843972 DOI: 10.1016/j.wneu.2024.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Pneumonia is one of the most common complications after spontaneous intracerebral hemorrhage (sICH), i.e., stroke-associated pneumonia (SAP). Timely identification of targeted patients is beneficial to reduce poor prognosis. So far, there is no consensus on SAP prediction, and application of existing predictors is limited. The aim of this study was to develop a machine learning model to predict SAP after sICH. METHODS We retrospectively reviewed 748 patients diagnosed with sICH and collected data from 4 dimensions-demographic features, clinical features, medical history, and laboratory tests. Five machine learning algorithms-logistic regression, gradient boosting decision tree, random forest, extreme gradient boosting, and category boosting-were used to build and validate the predictive model. We also applied recursive feature elimination with cross-validation to obtain the best feature combination for each model. Predictive performance was evaluated by area under the receiver operating characteristic curve. RESULTS SAP was diagnosed in 237 patients. The model developed by category boosting yielded the most satisfactory outcomes overall with area under the receiver operating characteristic curves in the training set and test set of 0.8307 and 0.8178, respectively. CONCLUSIONS The incidence of SAP after sICH in our center was 31.68%. Machine learning could potentially provide assistance in the prediction of SAP after sICH.
Collapse
Affiliation(s)
- Rui Guo
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siyu Yan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Yansheng Li
- DHC Mediway Technology Co., Ltd, Beijing, China
| | - Kejia Liu
- DHC Mediway Technology Co., Ltd, Beijing, China
| | - Fatian Wu
- DHC Mediway Technology Co., Ltd, Beijing, China
| | - Tianyu Feng
- DHC Mediway Technology Co., Ltd, Beijing, China
| | - Ruiqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
2
|
Lee CC, Su SY, Sung SF. Machine learning-based survival analysis approaches for predicting the risk of pneumonia post-stroke discharge. Int J Med Inform 2024; 186:105422. [PMID: 38518677 DOI: 10.1016/j.ijmedinf.2024.105422] [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: 01/14/2024] [Revised: 02/25/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Post-stroke pneumonia (PSP) is common among stroke patients. PSP occurring after hospital discharge continues to increase the risk of poor functional outcomes and death among stroke survivors. Currently, there is no prediction model specifically designed to predict the occurrence of PSP beyond the acute stage of stroke. This study aimed to explore the use of machine learning (ML) methods in predicting the risk of PSP after hospital discharge. METHODS This study analyzed data from 5,754 hospitalized stroke patients. The dataset was randomly divided into a training set and a holdout test set, with a ratio of 80:20. Several clinical and laboratory variables were utilized as predictors and different ML algorithms were employed to model time-to-event data. The ML model's predictive performance was compared to existing risk-scoring systems. A model-agnostic method based on Shapley additive explanations was utilized to interpret the ML model. RESULTS The study found that 5.7% of the study patients experienced pneumonia within one year after discharge. Based on repeated 5-fold cross-validation on the training set, the random survival forest (RSF) model had the highest C-index among the various ML algorithms and traditional Cox regression analysis. The final RSF model achieved a C-index of 0.787 (95% confidence interval: 0.737-0.840) on the holdout test set, outperforming five existing risk-scoring systems. The top three important predictors were the Glasgow Coma Scale score, age, and length of hospital stay. CONCLUSIONS The RSF model demonstrated superior discriminative ability compared to other ML algorithms and traditional Cox regression analysis, suggesting a non-linear relationship between predictors and outcomes. The developed ML model can be integrated into the hospital information system to provide personalized risk assessments.
Collapse
Affiliation(s)
- Chang-Ching Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-You Su
- Clinical Medicine Research Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; Department of Beauty & Health Care, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan.
| |
Collapse
|
3
|
Hu SQ, Hu JN, Chen RD, Yu JS. A predictive model using risk factor categories for hospital-acquired pneumonia in patients with aneurysmal subarachnoid hemorrhage. Front Neurol 2022; 13:1034313. [PMID: 36561302 PMCID: PMC9764336 DOI: 10.3389/fneur.2022.1034313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives To identify risk factors for hospital-acquired pneumonia (HAP) in patients with aneurysmal subarachnoid hemorrhage (aSAH) and establish a predictive model to aid evaluation. Methods The cohorts of 253 aSAH patients were divided into the HAP group (n = 64) and the non-HAP group (n = 189). Univariate and multivariate logistic regression were performed to identify risk factors. A logistic model (Model-Logit) was established based on the independent risk factors. We used risk factor categories to develop a model (Model-Cat). Receiver operating characteristic curves were generated to determine the cutoff values. Areas under the curves (AUCs) were calculated to assess the accuracy of models and single factors. The Delong test was performed to compare the AUCs. Results The multivariate logistic analysis showed that the age [p = 0.012, odds ratio (OR) = 1.059, confidence interval (CI) = 1.013-1.107], blood glucose (BG; >7.22 mmol/L; p = 0.011, OR = 2.781, CI = 1.263-6.119), red blood distribution width standard deviation (RDW-SD; p = 0.024, OR = 1.118, CI = 1.015-1.231), and Glasgow coma scale (GCS; p < 0.001, OR = 0.710, CI = 0.633-0.798) were independent risk factors. The Model-Logit was as follows: Logit(P) = -5.467 + 0.057 * Age + 1.023 * BG (>7.22 mmol/L, yes = 1, no = 0) + 0.111 * RDW-SD-0.342 * GCS. The AUCs values of the Model-Logit, GCS, age, BG (>7.22 mmol/L), and RDW-SD were 0.865, 0.819, 0.634, 0.698, and 0.625, respectively. For clinical use, the Model-Cat was established. In the Model-Cat, the AUCs for GCS, age, BG, and RDW-SD were 0.850, 0.760, 0.700, 0.641, and 0.564, respectively. The AUCs of the Model-Logit were insignificantly higher than the Model-Cat (Delong test, p = 0.157). The total points from -3 to 4 and 5 to 14 were classified as low- and high-risk levels, respectively. Conclusions Age, BG (> 7.22 mmol/L), GCS, and RDW-SD were independent risk factors for HAP in aSAH patients. The Model-Cat was convenient for practical evaluation. The aSAH patients with total points from 5 to 14 had a high risk for HAP, suggesting the need for more attention during treatment.
Collapse
Affiliation(s)
- Sheng-Qi Hu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian-Nan Hu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ru-Dong Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jia-Sheng Yu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
4
|
Szylińska A, Bott-Olejnik M, Wańkowicz P, Karoń D, Rotter I, Kotfis K. A Novel Index in the Prediction of Pneumonia Following Acute Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192215306. [PMID: 36430028 PMCID: PMC9690571 DOI: 10.3390/ijerph192215306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND The aim of our study was to search for predictive factors and to develop a model (index) for the risk of pneumonia following acute ischemic stroke. MATERIAL AND METHODS This study is an analysis of prospectively collected data from the neurology department of a district general hospital in Poland, comprising 1001 patients suffering from an acute ischemic stroke. Based on the medical data, the formula for the prediction of pneumonia was calculated. RESULTS Multivariate assessment for pneumonia occurrence was performed using the new PNEUMOINDEX. The study showed a significant increase in pneumonia risk with an increasing PNEUMOINDEX (OR non-adjusted = 2.738, p < 0.001). After accounting for age and comorbidities as confounders, the effect of the Index on pneumonia changed marginally (OR = 2.636, p < 0.001). CONCLUSIONS This study presents factors that show a significant association with the occurrence of pneumonia in patients with acute ischemic stroke. The calculated PNEUMOINDEX consists of data obtained at admission, namely NYHA III and IV heart failure, COPD, generalized atherosclerosis, NIHHS score on admission, and CRP/Hgb ratio, and shows high prediction accuracy in predicting hospital-acquired pneumonia in ischemic stroke patients.
Collapse
Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-204 Szczecin, Poland
| | - Marta Bott-Olejnik
- Department of Neurology, Regional Specialist Hospital in Gryfice, 72-300 Gryfice, Poland
| | - Paweł Wańkowicz
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-204 Szczecin, Poland
| | - Dariusz Karoń
- Department of Anesthesiology and Intensive Therapy, Regional Specialist Hospital in Gryfice, 72-300 Gryfice, Poland
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-204 Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 71-204 Szczecin, Poland
| |
Collapse
|
5
|
Tsai HC, Hsieh CY, Sung SF. Application of machine learning and natural language processing for predicting stroke-associated pneumonia. Front Public Health 2022; 10:1009164. [PMID: 36249261 PMCID: PMC9556866 DOI: 10.3389/fpubh.2022.1009164] [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: 08/01/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023] Open
Abstract
Background Identifying patients at high risk of stroke-associated pneumonia (SAP) may permit targeting potential interventions to reduce its incidence. We aimed to explore the functionality of machine learning (ML) and natural language processing techniques on structured data and unstructured clinical text to predict SAP by comparing it to conventional risk scores. Methods Linked data between a hospital stroke registry and a deidentified research-based database including electronic health records and administrative claims data was used. Natural language processing was applied to extract textual features from clinical notes. The random forest algorithm was used to build ML models. The predictive performance of ML models was compared with the A2DS2, ISAN, PNA, and ACDD4 scores using the area under the receiver operating characteristic curve (AUC). Results Among 5,913 acute stroke patients hospitalized between Oct 2010 and Sep 2021, 450 (7.6%) developed SAP within the first 7 days after stroke onset. The ML model based on both textual features and structured variables had the highest AUC [0.840, 95% confidence interval (CI) 0.806-0.875], significantly higher than those of the ML model based on structured variables alone (0.828, 95% CI 0.793-0.863, P = 0.040), ACDD4 (0.807, 95% CI 0.766-0.849, P = 0.041), A2DS2 (0.803, 95% CI 0.762-0.845, P = 0.013), ISAN (0.795, 95% CI 0.752-0.837, P = 0.009), and PNA (0.778, 95% CI 0.735-0.822, P < 0.001). All models demonstrated adequate calibration except for the A2DS2 score. Conclusions The ML model based on both textural features and structured variables performed better than conventional risk scores in predicting SAP. The workflow used to generate ML prediction models can be disseminated for local adaptation by individual healthcare organizations.
Collapse
Affiliation(s)
- Hui-Chu Tsai
- Department of Radiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan,Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan,*Correspondence: Sheng-Feng Sung ;
| |
Collapse
|
6
|
Ding Y, Ji Z, Liu Y, Niu J. Braden scale for predicting pneumonia after spontaneous intracerebral hemorrhage. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:904-911. [PMID: 35946766 PMCID: PMC9574960 DOI: 10.1590/1806-9282.20211339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Stroke-associated pneumonia is an infection that commonly occurs in patients with spontaneous intracerebral hemorrhage and causes serious burdens. In this study, we evaluated the validity of the Braden scale for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage. METHODS Patients with spontaneous intracerebral hemorrhage were retrospectively included and divided into pneumonia and no pneumonia groups. The admission clinical characteristics and Braden scale scores at 24 h after admission were collected and compared between the two groups. Receiver operating characteristic curve analysis was performed to assess the predictive validity of the Braden scale. Multivariable analysis was conducted to identify the independent risk factors associated with pneumonia after intracerebral hemorrhage. RESULTS A total of 629 intracerebral hemorrhage patients were included, 150 (23.8%) of whom developed stroke-associated pneumonia. Significant differences were found in age and fasting blood glucose levels between the two groups. The mean score on the Braden scale in the pneumonia group was 14.1±2.4, which was significantly lower than that in the no pneumonia group (16.5±2.6), p<0.001. The area under the curve for the Braden scale for the prediction of pneumonia after intracerebral hemorrhage was 0.760 (95%CI 0.717-0.804). When the cutoff point was 15 points, the sensitivity was 74.3%, the specificity was 64.7%, the accuracy was 72.0%, and the Youden's index was 39.0%. Multivariable analysis showed that a lower Braden scale score (OR 0.696; 95%CI 0.631-0.768; p<0.001) was an independent risk factor associated with stroke-associated pneumonia after intracerebral hemorrhage. CONCLUSION The Braden scale, with a cutoff point of 15 points, is moderately valid for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage.
Collapse
Affiliation(s)
- Yunlong Ding
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Neurology – Jiangsu, China
| | - Zhanyi Ji
- Zhoukou Central Hospital, Department of Neurology – Henan, China
| | - Yan Liu
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Neurology – Jiangsu, China
| | - Jiali Niu
- Affiliated Hospital of Yangzhou University, Jingjiang People's Hospital, Department of Clinical Pharmacy – Jiangsu, China
| |
Collapse
|
7
|
Yan J, Zhai W, Li Z, Ding L, You J, Zeng J, Yang X, Wang C, Meng X, Jiang Y, Huang X, Wang S, Wang Y, Li Z, Zhu S, Wang Y, Zhao X, Feng J. ICH-LR2S2: a new risk score for predicting stroke-associated pneumonia from spontaneous intracerebral hemorrhage. J Transl Med 2022; 20:193. [PMID: 35509104 PMCID: PMC9066782 DOI: 10.1186/s12967-022-03389-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We develop a new risk score to predict patients with stroke-associated pneumonia (SAP) who have an acute intracranial hemorrhage (ICH). Method We applied logistic regression to develop a new risk score called ICH-LR2S2. It was derived from examining a dataset of 70,540 ICH patients between 2015 and 2018 from the Chinese Stroke Center Alliance (CSCA). During the training of ICH-LR2S2, patients were randomly divided into two groups – 80% for the training set and 20% for model validation. A prospective test set was developed using 12,523 patients recruited in 2019. To further verify its effectiveness, we tested ICH-LR2S2 on an external dataset of 24,860 patients from the China National Stroke Registration Management System II (CNSR II). The performance of ICH-LR2S2 was measured by the area under the receiver operating characteristic curve (AUROC). Results The incidence of SAP in the dataset was 25.52%. A 24-point ICH-LR2S2 was developed from independent predictors, including age, modified Rankin Scale, fasting blood glucose, National Institutes of Health Stroke Scale admission score, Glasgow Coma Scale score, C-reactive protein, dysphagia, Chronic Obstructive Pulmonary Disease, and current smoking. The results showed that ICH-LR2S2 achieved an AUC = 0.749 [95% CI 0.739–0.759], which outperforms the best baseline ICH-APS (AUC = 0.704) [95% CI 0.694–0.714]. Compared with the previous ICH risk scores, ICH-LR2S2 incorporates fasting blood glucose and C-reactive protein, improving its discriminative ability. Machine learning methods such as XGboost (AUC = 0.772) [95% CI 0.762–0.782] can further improve our prediction performance. It also performed well when further validated by the external independent cohort of patients (n = 24,860), ICH-LR2S2 AUC = 0.784 [95% CI 0.774–0.794]. Conclusion ICH-LR2S2 accurately distinguishes SAP patients based on easily available clinical features. It can help identify high-risk patients in the early stages of diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03389-5.
Collapse
Affiliation(s)
- Jing Yan
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weiqi Zhai
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,Ministry of Education, Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Shanghai, 200433, China.,MOE Frontiers Center for Brain Science and Shanghai Institute of Artificial Intelligence Algorithms, Fudan University, Shanghai, 200433, China.,Zhangjiang Fudan International Innovation Center, Shanghai, 200433, China
| | - Zhaoxia Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - LingLing Ding
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jia You
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,Ministry of Education, Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Shanghai, 200433, China.,MOE Frontiers Center for Brain Science and Shanghai Institute of Artificial Intelligence Algorithms, Fudan University, Shanghai, 200433, China.,Zhangjiang Fudan International Innovation Center, Shanghai, 200433, China
| | - Jiayi Zeng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chunjuan Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaodi Huang
- School of Computing, Mathematics and Engineering, Charles Sturt University, Albury, NSW, 2640, Australia
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,Ministry of Education, Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Shanghai, 200433, China.,MOE Frontiers Center for Brain Science and Shanghai Institute of Artificial Intelligence Algorithms, Fudan University, Shanghai, 200433, China.,Zhangjiang Fudan International Innovation Center, Shanghai, 200433, China
| | - Yilong Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zixiao Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Chinese Institute for Brain Research, Beijing, China. .,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
| | - Shanfeng Zhu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China. .,Ministry of Education, Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Shanghai, 200433, China. .,MOE Frontiers Center for Brain Science and Shanghai Institute of Artificial Intelligence Algorithms, Fudan University, Shanghai, 200433, China. .,Zhangjiang Fudan International Innovation Center, Shanghai, 200433, China.
| | - Yongjun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xingquan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, 200433, China.,Ministry of Education, Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Shanghai, 200433, China.,MOE Frontiers Center for Brain Science and Shanghai Institute of Artificial Intelligence Algorithms, Fudan University, Shanghai, 200433, China.,Zhangjiang Fudan International Innovation Center, Shanghai, 200433, China
| |
Collapse
|
8
|
Li YM, Zhao L, Liu YG, Lu Y, Yao JZ, Li CJ, Lu W, Xu JH. Novel Predictors of Stroke-Associated Pneumonia: A Single Center Analysis. Front Neurol 2022; 13:857420. [PMID: 35432153 PMCID: PMC9007082 DOI: 10.3389/fneur.2022.857420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Stroke-associated pneumonia (SAP) is a common cause of disability or death. Although the researches on SAP have been relatively mature, the method that can predict SAP with great accuracy has not yet been determined. It is necessary to discover new predictors to construct a more accurate predictive model for SAP. We continuously collected 2,366 patients with acute ischemic stroke, and then divided them into the SAP group and non-SAP group. Data were recorded at admission. Through univariate analyses and multivariate regression analyses of the data, the new predictive factors and the predictive model of SAP were determined. The receiver operating characteristic (ROC) curve and the corresponding area under the curve (AUC) were used to measure their predictive accuracy. Of the 2,366 patients, 459 were diagnosed with SAP. International normalized ratio (INR) (odds ratio = 37.981; 95% confidence interval, 7.487–192.665; P < 0.001), age and dysphagia were independent risk factors of SAP. However, walking ability within 48 h of admission (WA) (odds ratio = 0.395; 95% confidence interval, 0.287–0.543; P < 0.001) was a protective factor of SAP. Different predictors and the predictive model all could predict SAP (P < 0.001). The predictive power of the model (AUC: 0.851) which included age, homocysteine, INR, history of chronic obstructive pulmonary disease (COPD), dysphagia, and WA was greater than that of age (AUC: 0.738) and INR (AUC: 0.685). Finally, we found that a higher INR and no WA could predict SAP in patients with acute ischemic stroke. In addition, we designed a simple and practical predictive model for SAP, which showed relatively good accuracy. These findings might help identify high-risk patients with SAP and provide a reference for the timely use of preventive antibiotics.
Collapse
|
9
|
Xu J, Yang Z. Risk factors and pathogenic microorganism characteristics for pneumonia in convalescent patients with stroke: A retrospective study of 380 patients from a rehabilitation hospital. J Stroke Cerebrovasc Dis 2020; 29:104955. [PMID: 32689631 PMCID: PMC7221409 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/23/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pneumonia is a major complication leading to death after stroke. The risk factors of pneumonia in convalescent patients who have experienced stroke remain poorly defined. METHODS To identify the risk factors of pneumonia, we applied logistic regression as a statistical method using SPSS23.0 statistical software, based on a sample of 380 patients. And statistical description method was used to analyze pathogens' characteristics and drug resistance. RESULTS Ultimately, the obtained logistic model has statistical significance (χ2(13) = 91.560, P <0.0005). The sensitivity of the model is 41.7%, the specificity is 97.6%, the positive predictive value is 76.9%, and the negative predictive value is 89.8%. The Barthel index (BI) (OR=1.97, 95% CI: 1.01-3.87), basic lung diseases (OR=4.24, 95% CI: 1.02-17.61), trachea ventilation (OR=6.56, 95% CI: 1.18-36.34), feeding tube (OR=6.06, 95% CI: 2.59-14.18), and hypoproteinemia (OR=3.97, 95% CI: 1.56-10.10) were statistically significant (P<0.05). Among patients who have pneumonia, the proportion of gram-positive bacteria, gram-negative bacteria and fungal infection is 10.00%, 54.29%, 5.71% respectively. The study most frequently isolated Pseudomonas aeruginosa (18.57%), followed by Acinetobacter baumannii (10.00%,) and Klebsiella pneumoniae (10.00%). The drug resistance rate of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae to different antibiotics ranged from 0.00-37.77%, 0.00-85.71% and 0.00-57.14%, respectively. CONCLUSIONS The lower BI scores, basic lung diseases, trachea ventilation, tube feeding, and hypoproteinemia are independent risk factors of pneumonia among convalescent patients with stroke. The main pathogens that caused pneumonia were gram-negative bacteria, and such organisms have different degrees of resistance to drugs.
Collapse
Affiliation(s)
- Jia Xu
- Department of pharmacy, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.89 Guhan Road, Furong district, Changsha, Hunan 410016, China
| | - Zhiling Yang
- Department of pharmacy, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.89 Guhan Road, Furong district, Changsha, Hunan 410016, China.
| |
Collapse
|
10
|
Li X, Wu M, Sun C, Zhao Z, Wang F, Zheng X, Ge W, Zhou J, Zou J. Using machine learning to predict stroke‐associated pneumonia in Chinese acute ischaemic stroke patients. Eur J Neurol 2020; 27:1656-1663. [PMID: 32374076 DOI: 10.1111/ene.14295] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
- X. Li
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - M. Wu
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Pharmacy Nanjing Drum Tower Hospital Medical College of Nanjing University Nanjing China
| | - C. Sun
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - Z. Zhao
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - F. Wang
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - X. Zheng
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - W. Ge
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Pharmacy Nanjing Drum Tower Hospital Medical College of Nanjing University Nanjing China
| | - J. Zhou
- Department of Neurology Nanjing First Hospital Nanjing Medical University Nanjing China
| | - J. Zou
- School of Basic Medicine and Clinical Pharmacy China Pharmaceutical University Nanjing China
- Department of Clinical Pharmacology Nanjing First Hospital Nanjing Medical University Nanjing China
| |
Collapse
|
11
|
Quyet D, Hien NM, Khan MX, Dai PD, Thuan DD, Duc DM, Hai ND, Nam BV, Huy PQ, Ton MD, Truong DT, Nga VT, Duc DP. Risk Factors for Stroke Associated Pneumonia. Open Access Maced J Med Sci 2019; 7:4416-4419. [PMID: 32215105 PMCID: PMC7084006 DOI: 10.3889/oamjms.2019.873] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Stroke patients are at high risk for stroke-associated pneumonia (SAP). If patients suffer from pneumonia their prognosis will worsen. AIM: To identify factors that increases the risk of SAP in stroke patients. METHODS: A group of 508 patients hospitalized within 5 days after the onset of stroke were enrolled prospectively. RESULTS: The incidence of SAP was 13.4%. Some major risk factors for SAP are: mechanical ventilation (MV) had odds ratio (OR) 16.4 (p <0.01); the National Institutes of Health Stroke Scale (NIHSS) > 15 OR 9.1 (p <0.01); the Gugging Swallowing Screen (GUSS) 0-14 OR 11.7 (p <0.01). CONCLUSION: SAP is a frequent complication. We identified some risk factors of SAP, especially stroke severity (NIHSS > 15), swallowing disorder (GUSS < 15) and mechanical ventilation.
Collapse
Affiliation(s)
- Do Quyet
- Respiratory Center, Military Hospital 103, Hanoi, Vietnam
| | | | - Mai Xuan Khan
- Respiratory Center, Military Hospital 103, Hanoi, Vietnam
| | - Pham Dinh Dai
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Do Duc Thuan
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Dang Minh Duc
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | | | - Bui Van Nam
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| | - Pham Quoc Huy
- Emergency Department, Military Hospital 103, Hanoi, Vietnam
| | - Mai Duy Ton
- Emergency Department, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, Danang, Vietnam
| | - Dang Phuc Duc
- Stroke Department, Military Hospital 103, Hanoi, Vietnam
| |
Collapse
|
12
|
Li J, Wang Y, Sun X, Lin J, Lai R, Liang J, Wu X, Sheng W. AND score: a simple tool for predicting infection in acute ischemic stroke patients without a ventilator in the Chinese population. J Int Med Res 2019; 48:300060519888303. [PMID: 31802712 PMCID: PMC7783280 DOI: 10.1177/0300060519888303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective We aimed to develop a simple and user-friendly scoring system to predict
all-cause hospital-acquired infections (HAIs) after acute ischemic stroke
(AIS) in the Chinese population. Methods AIS patients from a retrospective cohort study at our center were included
from January 2016 to December 2018. HAIs were diagnosed based on the current
criteria from Ministry of Health of the People’s Republic of China. Stepwise
logistic regression models were performed to screen independent predictors
of HAI after AIS. A scoring system was developed by including each of the
above significant predictors. Results Among 1211 patients, 76 patients (6.28%) developed HAI. Age, baseline
National Institute of Health stroke scale (NIHSS) score, and dysphagia were
independent predictors of HAI. For the AND score, A refers to age, N refers
to NIHSS, and D refers to dysphagia. The AND score showed a high area under
the receiver operating characteristics (AUROC) curve (0.679), which
comprised age (65–74 years was 4 points, 75–84 years was 6 points, ≥85 years
was 8 points), NIHSS score ≥10 (5 points), and dysphagia (6 points). Conclusions We developed a simple scoring system to predict all-cause infections after
AIS patients without a ventilator in the Chinese population.
Collapse
Affiliation(s)
- Jiaoxing Li
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yufang Wang
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xunsha Sun
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Lin
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rong Lai
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Liang
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoxin Wu
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenli Sheng
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
13
|
Ding Y, Yan Y, Niu J, Zhang Y, Gu Z, Tang P, Liu Y. Braden scale for assessing pneumonia after acute ischaemic stroke. BMC Geriatr 2019; 19:259. [PMID: 31590645 PMCID: PMC6781366 DOI: 10.1186/s12877-019-1269-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
Background The prevention of pneumonia is critical for patients with acute ischaemic stroke (AIS). The six subscales in the Braden Scale seem to be related to the occurrence of pneumonia. We aimed to evaluate the feasibility of using the Braden Scale to predict the occurrence of pneumonia after AIS. Methods We studied a series of consecutive patients with AIS who were admitted to the hospital. The cohort was subdivided into pneumonia and no pneumonia groups. The scores on the Braden Scale, demographic characteristics and clinical characteristics were obtained and analysed by statistical comparisons between the two groups. We investigated the predictive validity of the Braden Scale by receiver operating characteristic (ROC) curve analysis. Results A total of 414 patients with AIS were included in this study. Of those 414 patients, 57 (13.8%) patients fulfilled the criteria for post-stroke pneumonia. There were significant differences in age and histories of chronic obstructive pulmonary disease (COPD), dysphagia and Glasgow Coma Scale (GCS) score between the two groups, and the National Institutes of Health Stroke Scale (NIHSS) score in the pneumonia group was significantly higher than that in the no pneumonia group (P < 0.01). The mean score on the Braden Scale in the pneumonia group was significantly lower than that in the no pneumonia group (P < 0.01). The six subscale scores on the Braden Scale were all significantly different between the two groups. The area under the curve (AUC) for the Braden Scale for the prediction of pneumonia after AIS was 0.883 (95% CI = 0.828–0.937). With 18 points as the cutoff point, the sensitivity was 83.2%, and the specificity was 84.2%. Conclusion The Braden Scale with 18 points as the cutoff point is likely a valid clinical grading scale for predicting pneumonia after AIS at presentation. Further studies on the association of the Braden Scale score with stroke outcomes are needed.
Collapse
Affiliation(s)
- Yunlong Ding
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China
| | - Yazhou Yan
- Department of Neurosurgery, Changhai Hospital affiliated to the Second Military Medical University, Shanghai, China
| | - Jiali Niu
- Department of Clinical Pharmacy, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, Jiangsu, China
| | - Yanrong Zhang
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China
| | - Zhiqun Gu
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China
| | - Ping Tang
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China.
| | - Yan Liu
- Department of Neurology, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, No. 28, Zhongzhou Road, Jingjiang, CN 214500, Jiangsu, China.
| |
Collapse
|
14
|
Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
15
|
Marchina S, Doros G, Modak J, Helenius J, Aycock DM, Kumar S. Acid-suppressive medications and risk of pneumonia in acute stroke patients: A systematic review and meta-analysis. J Neurol Sci 2019; 400:122-128. [DOI: 10.1016/j.jns.2019.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/20/2018] [Accepted: 02/28/2019] [Indexed: 01/08/2023]
|
16
|
Kołpa M, Wałaszek M, Różańska A, Wolak Z, Wójkowska-Mach J. Hospital-Wide Surveillance of Healthcare-Associated Infections as a Source of Information about Specific Hospital Needs. A 5-Year Observation in a Multiprofile Provincial Hospital in the South of Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1956. [PMID: 30205510 PMCID: PMC6164515 DOI: 10.3390/ijerph15091956] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/28/2018] [Accepted: 09/05/2018] [Indexed: 11/16/2022]
Abstract
Healthcare-associated infections (HAIs) are adverse complications of hospitalisation resulting in delayed recovery and increased costs. The aim of this study was an analysis of epidemiological factors obtained in the framework of constant, comprehensive (hospital-wide) infection registration, and identification of priorities and needs in infection control, both with regard to targeted surveillance, as well as preventative actions. The study was carried out according to the methodology recommended by the HAI-Net (Surveillance Network) coordinated by the European Centre for Disease Prevention and Control, in the multiprofile hospital in Southern Poland, between 2012 and 2016. A total of 159,028 patients were under observation and 2184 HAIs were detected. The incidence was 1.4/100 admissions (2.7/1000 patient-das of hospitalisation) and significantly differed depending on the type of the patient care: in intensive care units (ICU) 16.9%; in surgical units, 1.3%; non-surgical units, 1.0%; and paediatric units, 1.8%. The most common HAI was gastrointestinal infections (GIs, 28.9%), followed by surgical site infections (SSIs, 23.0%) and bloodstream infections (BSIs, 16.1%). The vast majority of GIs, BSIs, urinary tract infections, and incidents of pneumonia (PN) were detected in non-ICUs. As many as 33.2% of cases of HAI were not confirmed microbiologically. The most frequently detected etiologic agent of infections was Clostridium difficile-globally and in GI (49%). Comprehensive analysis of the results allowed to identify important elements of surveillance of infections, i.e., surveillance of GI, PN, and BSI not only in ICU, but also in non-ICU wards, indicating a need for implementing rapid actions to improve compliance with HAI prevention procedures.
Collapse
Affiliation(s)
- Małgorzata Kołpa
- State Higher Vocational School in Tarnów, St. Luke's Provincial Hospital in Tarnów, 33-100 Tarnów, Poland.
| | - Marta Wałaszek
- State Higher Vocational School in Tarnów, St. Luke's Provincial Hospital in Tarnów, 33-100 Tarnów, Poland.
| | - Anna Różańska
- Department of Microbiology, Jagiellonian University, Polish Society of Hospital Infections, 31-121 Kraków, Poland.
| | - Zdzisław Wolak
- State Higher Vocational School in Tarnów, St. Luke's Provincial Hospital in Tarnów, 33-100 Tarnów, Poland.
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Jagiellonian University, Polish Society of Hospital Infections, 31-121 Kraków, Poland.
| |
Collapse
|
17
|
Westendorp WF, Vermeij JD, Hilkens NA, Brouwer MC, Algra A, van der Worp HB, Dippel DW, van de Beek D, Nederkoorn PJ. Development and internal validation of a prediction rule for post-stroke infection and post-stroke pneumonia in acute stroke patients. Eur Stroke J 2018; 3:136-144. [PMID: 29900413 PMCID: PMC5992742 DOI: 10.1177/2396987318764519] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Patients with acute stroke are at high risk for infection. These infections are associated with unfavourable outcome after stroke. A prediction rule can identify the patients at the highest risk for strategies to prevent infection. We aim to develop a prediction rule for post-stroke pneumonia and other infections in patients with acute stroke. Patients and methods We used data from the Preventive Antibiotics in Stroke Study, a multicentre randomised trial comparing preventive ceftriaxone vs. standard stroke care in patients with acute stroke. Possible predictors for post-stroke pneumonia or infection were selected from the literature. Backward elimination logistic regression analysis was used to construct prediction rules for pneumonia or infection. Internal validation was performed and a risk chart was constructed. We adjusted for preventive antibiotic use. Results Pneumonia was diagnosed in 159 of the 2538 included patients, and infection in 348. Pneumonia was predicted by higher age, male sex, pre-stroke disability, medical history of chronic obstructive pulmonary disease, more severe stroke, dysphagia and intracerebral haemorrhage (rather than ischaemic stroke). Infections were predicted by higher age, male sex, history of diabetes, chronic obstructive pulmonary disease, more severe stroke, dysphagia, use of bladder catheter, preventive antibiotic use and intracerebral haemorrhage. With the prediction rule developed, risks for pneumonia ranged from 0.4% to 56.2% and from 1.8% to 88.0% for infection. Discrimination of the score was good (C-statistic, 0.84; 95% CI: 0.81–0.87 and 0.82; 95% CI: 0.79–0.84 for pneumonia and infection). Conclusions The Preventive Antibiotics in Stroke Study pneumonia and infection rule identify patients at the highest risk for post-stroke pneumonia or infection and may be used for future studies and novel therapies, after confirmation in an external population.
Collapse
Affiliation(s)
- Willeke F Westendorp
- 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Jan-Dirk Vermeij
- 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Nina A Hilkens
- 2Department of Neurology & Neurosurgery and Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Matthijs C Brouwer
- 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Ale Algra
- 2Department of Neurology & Neurosurgery and Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - H Bart van der Worp
- 3Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Diederik Wj Dippel
- 4Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Diederik van de Beek
- 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Pual J Nederkoorn
- 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| |
Collapse
|