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Zhang W, Zhou Y, Xu L, Qiu C, Luo Z, Jiang Z, Tao X, Wu Y, Yao S, Huang H, Wang X, Yang Y, Lin R. Development and validation of radiology-clinical statistical and machine learning model for stroke-associated pneumonia after first intracerebral haemorrhage. BMC Pulm Med 2024; 24:357. [PMID: 39048959 PMCID: PMC11267827 DOI: 10.1186/s12890-024-03160-0] [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: 11/06/2023] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Society is burdened with stroke-associated pneumonia (SAP) after intracerebral haemorrhage (ICH). Cerebral small vessel disease (CSVD) complicates clinical manifestations of stroke. In this study, we redefined the CSVD burden score and incorporated it into a novel radiological-clinical prediction model for SAP. MATERIALS AND METHODS A total of 1278 patients admitted to a tertiary hospital between 1 January 2010 and 31 December 2019 were included. The participants were divided into training and testing groups using fivefold cross-validation method. Four models, two traditional statistical models (logistic regression and ISAN) and two machine learning models (random forest and support vector machine), were established and evaluated. The outcomes and baseline characteristics were compared between the SAP and non-SAP groups. RESULTS Among the of 1278 patients, 281(22.0%) developed SAP after their first ICH. Multivariate analysis revealed that the logistic regression (LR) model was superior in predicting SAP in both the training and testing groups. Independent predictors of SAP after ICH included total CSVD burden score (OR, 1.29; 95% CI, 1.03-1.54), haematoma extension into ventricle (OR, 2.28; 95% CI, 1.87-3.31), haematoma with multilobar involvement (OR, 2.14; 95% CI, 1.44-3.18), transpharyngeal intubation operation (OR, 3.89; 95% CI, 2.7-5.62), admission NIHSS score ≥ 10 (OR, 2.06; 95% CI, 1.42-3.01), male sex (OR, 1.69; 95% CI, 1.16-2.52), and age ≥ 67 (OR, 2.24; 95% CI, 1.56-3.22). The patients in the SAP group had worse outcomes than those in the non-SAP group. CONCLUSION This study established a clinically combined imaging model for predicting stroke-associated pneumonia and demonstrated superior performance compared with the existing ISAN model. Given the poor outcomes observed in patients with SAP, the use of individualised predictive nomograms is vital in clinical practice.
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Affiliation(s)
- Wenru Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ying Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liuhui Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chaomin Qiu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhixian Luo
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Xinyi Tao
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingjie Wu
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shishi Yao
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hang Huang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Alzheimer's Disease of Zhejiang Province, Institute of Aging, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ru Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Hao F, Li S, Yu L, Hu Y, Chen L, Cai W. A retrospective study on the prevalence and risk factors of neurogenic lower urinary tract dysfunction for acute ischemic stroke in China: A case-control study. Investig Clin Urol 2024; 65:368-377. [PMID: 38978217 PMCID: PMC11231667 DOI: 10.4111/icu.20240006] [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: 01/03/2024] [Revised: 03/15/2024] [Accepted: 04/15/2024] [Indexed: 07/10/2024] Open
Abstract
PURPOSE This study identified risk factors for neurogenic lower urinary tract dysfunction (NLUTD) in patients with acute ischemic stroke (AIS) through multidimensional analysis of the medical records of patients, aiming to reduce the incidence of NLUTD, improve prognosis, and facilitate rehabilitation. MATERIALS AND METHODS In this case-control study, patients with AIS were recruited from two tertiary general hospitals in Shenzhen, China, from March 2021 to October 2023. Patients were divided into NLUTD and non-NLUTD groups based on the presence and absence of NLUTD, respectively. Comparative analysis was performed using the Mann-Whitney U and chi-square tests, with significant variables being included in logistic regression analysis. RESULTS Of the 652 participants enrolled in this study, 119 participants (18.3%) developed NLUTD. Bivariate analysis showed that 39 of 54 screened factors exhibited a significant correlation (p<0.05) with the incidence of NLUTD after AIS. Significant variables identified through logistic regression analysis included Glasgow coma scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores, anemia, aphasia, pneumonia, brainstem involvement, multiple lesions, urine clarity (CLA), random venous blood glucose (GLU) and hemoglobin (HGB) levels, and white blood cell (WBC) count. CONCLUSIONS A total of 11 risk factors for NLUTD were identified in this study. This finding provides valuable guidance for reducing the incidence of NLUTD after AIS and improving the quality of life of patients.
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Affiliation(s)
- Fengming Hao
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Shuxian Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Lanlan Yu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yingjie Hu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenzhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- School of Nursing, Southern Medical University, Guangzhou, China.
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Darwish M, El-Tamawy MS, Mahmoud A, Ali AS, Khalifa HA. The impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2108. [PMID: 38970291 DOI: 10.1002/pri.2108] [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: 01/12/2024] [Revised: 05/21/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Dysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients. METHODS A single-blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65 years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40 min/session, 1 session/day, and 5 days/week for 4 weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4 weeks of intervention for both groups. RESULTS Before treatment, all patients were susceptible to pneumonia after two and 4 weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p < 0.05) and a statistically significant increase in incidence of SAP after 2 weeks of intervention only in the control group (p < 0.05). The results also showed a significant negative correlation between GUSS score and SAP (r = - 0.3662, p = 0.0018) IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients.
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Affiliation(s)
- Moshera Darwish
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Aya Mahmoud
- Department of Physical Therapy for Neurology, Kasr El-Aini hospitals, Cairo University, Cairo, Egypt
| | - Ahmed S Ali
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Al-Qurayyat, Saudi Arabia
| | - Heba A Khalifa
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Al-Qurayyat, Saudi Arabia
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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.
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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.
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Chongolo AM, Alphonce B, Mbelele PM, Meda J, Nyundo A. Predictors of 30-day mortality following the first episode of stroke among patients admitted at referral hospitals in Dodoma, central Tanzania: A prospective longitudinal observational study. Health Sci Rep 2024; 7:e2198. [PMID: 38933419 PMCID: PMC11199172 DOI: 10.1002/hsr2.2198] [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: 09/05/2023] [Revised: 05/12/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Background and Aims Stroke is the leading cause of disability and the second most common cause of death after ischemic heart disease worldwide. Understanding predictors of early poststroke mortality provides opportunities for interventions and favorable outcomes. This study aimed to determine the incidence and predictors of 30-day mortality among patients admitted with the first stroke at referral hospitals in Dodoma. Methods A prospective longitudinal observational design enrolled patients with acute stroke confirmed by CT scan or MRI admitted at referral hospitals in Dodoma. The National Institute of Health Stroke Scale was used to assess stroke severity at baseline. A comparison of risk factors, clinical profiles, and mortality was done using the Chi-square test. A logistic regression model was used to determine the predictors of 30-day mortality in patients with the stroke while the 30-day probability of survival was estimated using Kaplan-Meier analysis. Results Out of 226 patients with first-ever stroke, 121(54%) were males, and the population mean age was 63(15) years. The 140(62%) had Ischemic stroke, and 154(68%) survived at the 30th day. Patients with a history of smoking 2.4 [95% confidence interval (CI) (1.0-5.6), p = 0.048], loss of consciousness 2.7 [95% CI (1.2-6.4; p = 0.019] and unequal pupil size 13.7 [95% CI (4.1-58.1, p < 0.001 were significantly more associated with mortality within 30 days. The median survival was 7 (3-9) days, whereas alcohol drinkers and those aged above 60 years had a shorter time to mortality compared to non-alcohol drinkers and those aged <60 years. Conclusion The study showed a high incidence of mortality within 30 days after the first stroke episode, with the highest proportion dying within 7 days of being hospitalized. Advanced age of ≥60 years, smoking, alcohol use, and severe stroke at admission warrant special attention.
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Affiliation(s)
- Anna M. Chongolo
- Kibong'oto Infectious Diseases HospitalSihaTanzania
- Department of Internal Medicine, School of Medicine and DentistryThe University DodomaDodomaTanzania
| | - Baraka Alphonce
- Department of Internal Medicine, School of Medicine and DentistryThe University DodomaDodomaTanzania
| | | | - John Meda
- Department of Internal Medicine, School of Medicine and DentistryThe University DodomaDodomaTanzania
- Department of CardiologyThe Benjamin Mkapa HospitalDodomaTanzania
- Department of Internal MedicineThe Benjamin Mkapa HospitalDodomaTanzania
| | - Azan Nyundo
- Department of Internal Medicine, School of Medicine and DentistryThe University DodomaDodomaTanzania
- Department of Internal MedicineThe Benjamin Mkapa HospitalDodomaTanzania
- Department of Psychiatry and Mental Health, School of Medicine and DentistryThe University of DodomaDodomaTanzania
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Liao KM, Lu HY, Chen CY, Kuo LT, Tang BR. The impact of comorbidities on prolonged mechanical ventilation in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2024; 24:257. [PMID: 38796444 PMCID: PMC11128105 DOI: 10.1186/s12890-024-03068-9] [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: 10/29/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND In patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure, approximately 10% of them are considered to be at high risk for prolonged mechanical ventilation (PMV, > 21 days). PMV have been identified as independent predictors of unfavorable outcomes. Our previous study revealed that patients aged 70 years older and COPD severity were at a significantly higher risk for PMV. We aimed to analyze the impact of comorbidities and their associated risks in patients with COPD who require PMV. METHODS The data used in this study was collected from Kaohsiung Medical University Hospital Research Database. The COPD subjects were the patients first diagnosed COPD (index date) between January 1, 2012 and December 31, 2020. The exclusion criteria were the patients with age less than 40 years, PMV before the index date or incomplete records. COPD and non-COPD patients, matched controls were used by applying the propensity score matching method. RESULTS There are 3,744 eligible patients with COPD in the study group. The study group had a rate of 1.6% (60 cases) patients with PMV. The adjusted HR of PMV was 2.21 (95% CI 1.44-3.40; P < 0.001) in the COPD patients than in non-COPD patients. Increased risks of PMV were found significantly for patients with diabetes mellitus (aHR 4.66; P < 0.001), hypertension (aHR 3.20; P = 0.004), dyslipidemia (aHR 3.02; P = 0.015), congestive heart failure (aHR 6.44; P < 0.001), coronary artery disease (aHR 3.11; P = 0.014), stroke (aHR 6.37; P < 0.001), chronic kidney disease (aHR 5.81 P < 0.001) and Dementia (aHR 5.78; P < 0.001). CONCLUSIONS Age, gender, and comorbidities were identified as significantly higher risk factors for PMV occurrence in the COPD patients compared to the non-COPD patients. Beyond age, comorbidities also play a crucial role in PMV in COPD.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan.
| | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Bo-Ren Tang
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
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Ruggles A, Benakis C. Exposure to Environmental Toxins: Potential Implications for Stroke Risk via the Gut- and Lung-Brain Axis. Cells 2024; 13:803. [PMID: 38786027 PMCID: PMC11119296 DOI: 10.3390/cells13100803] [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: 04/02/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Recent evidence indicates that exposure to environmental toxins, both short-term and long-term, can increase the risk of developing neurological disorders, including neurodegenerative diseases (i.e., Alzheimer's disease and other dementias) and acute brain injury (i.e., stroke). For stroke, the latest systematic analysis revealed that exposure to ambient particulate matter is the second most frequent stroke risk after high blood pressure. However, preclinical and clinical stroke investigations on the deleterious consequences of environmental pollutants are scarce. This review examines recent evidence of how environmental toxins, absorbed along the digestive tract or inhaled through the lungs, affect the host cellular response. We particularly address the consequences of environmental toxins on the immune response and the microbiome at the gut and lung barrier sites. Additionally, this review highlights findings showing the potential contribution of environmental toxins to an increased risk of stroke. A better understanding of the biological mechanisms underlying exposure to environmental toxins has the potential to mitigate stroke risk and other neurological disorders.
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Affiliation(s)
| | - Corinne Benakis
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, 81337 Munich, Germany;
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Jiang X, Hu Y, Wang J, Ma M, Bao J, Fang J, He L. Outcomes and risk factors for infection after endovascular treatment in patients with acute ischemic stroke. CNS Neurosci Ther 2024; 30:e14753. [PMID: 38727582 PMCID: PMC11086021 DOI: 10.1111/cns.14753] [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: 02/17/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
AIMS Infection is a common complication following acute ischemic stroke (AIS) and significantly contributes to poor functional outcomes after stroke. This study aimed to investigate the effects of infection after endovascular treatment (post-EVT infection) on clinical outcomes and risk factors in patients with AIS. METHODS We retrospectively analyzed AIS patients treated with endovascular treatment (EVT) between January 2016 and December 2022. A post-EVT infection was defined as any infection diagnosed within 7 days after EVT. The primary outcome was functional independence, defined as a modified Rankin scale (mRS) score of 0-2 at 90 days. A multivariable logistic regression analysis was conducted to determine independent predictors of post-EVT infection and the associations between post-EVT infection and clinical outcomes. RESULTS A total of 675 patients were included in the analysis; 306 (45.3%) of them had post-EVT infections. Patients with post-EVT infection had a lower rate of functional independence than patients without infection (31% vs 65%, p = 0.006). In addition, patients with post-EVT infection achieved less early neurological improvement (ENI) after EVT (25.8% vs 47.4%, p < 0.001). For safety outcomes, the infection group had a higher incidence of any intracranial hemorrhage (23.9% vs 15.7%, p = 0.01) and symptomatic intracranial hemorrhage (10.1% vs 5.1%, p = 0.01). Unsuccessful recanalization (aOR 1.87, 95% CI 1.11-3.13; p = 0.02) and general anesthesia (aOR 2.22, 95% CI 1.25-3.95; p = 0.01) were identified as independent predictors for post-EVT infection in logistic regression analysis. CONCLUSION AIS patients who develop post-EVT infections are more likely to experience poor clinical outcomes. Unsuccessful recanalization and general anesthesia were independent risk factors for the development of post-EVT infection.
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Affiliation(s)
- Xin Jiang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Yaowen Hu
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Jian Wang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Mengmeng Ma
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Jiajia Bao
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Jinghuan Fang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Li He
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
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Hong I, Norman RS, Woo HS, Jin Y, Reistetter TA. Dysphagia and Functional Limitations Among Adults in the United States: Findings from the 2022 National Health Interview Survey. Dysphagia 2024:10.1007/s00455-024-10680-8. [PMID: 38502346 DOI: 10.1007/s00455-024-10680-8] [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: 09/19/2023] [Accepted: 02/01/2024] [Indexed: 03/21/2024]
Abstract
Dysphagia or swallowing dysfunction is associated with reduced quality of life and poor long term outcomes. While standard dysphagia treatment focuses on improving swallowing function, it is not clear if people with dysphagia also have difficulties performing daily tasks. This study aimed to determine if individuals with dysphagia had difficulties with participating in daily tasks requiring physical function, as compared to those with no dysphagia. We conducted a secondary data analysis using the responses of 24,107 adults aged 18 years or older who completed the 2022 National Health Interview Survey. The independent variable was report of swallowing problem during the past 12 months, and the dependent variables were report of difficulty in physical function tasks (e.g., self-care, mobility, working, social participation). We utilized propensity score methods to balance demographic and clinical variables between groups, and examined if individuals with dysphagia had more difficulties with the physical function tasks. The propensity score methods balanced the demographic and clinical variables (absolute standardized differences < 0.1). People with dysphagia had significantly higher odds ratios (ranged from 1.23 to 1.70, all p < 0.05) of having difficulties in physical function tasks than those without dysphagia. The findings revealed an association between experiencing dysphagia and encountering difficulties in self-care, mobility, working, and social participation in the general adult population in the US. Results of our study indicate that during the course of rehabilitation, healthcare professionals should consider the potential impact of dysphagia symptoms on clients' ability to partake in independent activities in their community settings.
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Affiliation(s)
- Ickpyo Hong
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
| | - Rocío S Norman
- Department of Communication Sciences and Disorders, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Hee-Soon Woo
- Department of Occupational Therapy, Wonkwang University, Iksan, Korea.
| | - Yeonju Jin
- Graduate School, Yonsei University, Wonju, Korea
| | - Timothy A Reistetter
- Department of Occupational Therapy, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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10
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Wang J, Yang C, Zhang R, Hu W, Yang P, Jiang Y, Hong W, Shan R, Jiang Y. Development and validation of a predictive model for stroke associated pneumonia in patients after thrombectomy for acute ischemic stroke. Front Med (Lausanne) 2024; 11:1370986. [PMID: 38504915 PMCID: PMC10948544 DOI: 10.3389/fmed.2024.1370986] [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: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Objective This study aims to identify the risk factors associated with stroke-associated pneumonia (SAP) in patients who have undergone thrombectomy for acute ischemic stroke and to develop a nomogram chart model for predicting the occurrence of pneumonia. Methods Consecutive patients who underwent thrombectomy for acute ischemic stroke were enrolled from three hospitals at Taizhou Enze Medical Center. They were randomly divided into a training group and a validation group in a 7:3 ratio. The training group data was used to screen for effective predictive factors using LASSO regression. Multiple logistic regression was then conducted to determine the predictive factors and construct a nomogram chart. The model was evaluated using the validation group, analyzing its discrimination, calibration, and clinical decision curve. Finally, the newly constructed model was compared with the AIS-APS, A2DS2, ISAN, and PANTHERIS scores for acute ischemic stroke-associated pneumonia. Results Out of 913 patients who underwent thrombectomy, 762 were included for analysis, consisting of 473 males and 289 females. The incidence rate of SAP was 45.8%. The new predictive model was constructed based on three main influencing factors: NIHSS ≥16, postoperative LMR, and difficulty swallowing. The model demonstrated good discrimination and calibration. When applying the nomogram chart to threshold probabilities between 7 and 90%, net returns were increased. Furthermore, the AUC was higher compared to other scoring systems. Conclusion The constructed nomogram chart in this study outperformed the AIS-APS, A2DS2 score, ISAN score, and PANTHERIS score in predicting the risk of stroke-associated pneumonia in patients with acute ischemic stroke after thrombectomy. It can be utilized for clinical risk prediction of stroke-associated pneumonia in patients after thrombectomy for acute ischemic stroke.
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Affiliation(s)
- Jingying Wang
- Department of Emergency Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Chao Yang
- Department of Emergency Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Ruihai Zhang
- Department of Neurosurgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Wei Hu
- Department of Neurosurgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Peng Yang
- Department of Emergency Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yiqing Jiang
- Department of Neurology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Weijun Hong
- Department of Neurology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Renfei Shan
- Department of Emergency Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yongpo Jiang
- Department of Emergency Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
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11
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Dai L, Yang X, Li H, Zhao X, Lin L, Jiang Y, Wang Y, Li Z, Shen H. A clinically actionable and explainable real-time risk assessment framework for stroke-associated pneumonia. Artif Intell Med 2024; 149:102772. [PMID: 38462273 DOI: 10.1016/j.artmed.2024.102772] [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: 08/02/2022] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 03/12/2024]
Abstract
The current medical practice is more responsive rather than proactive, despite the widely recognized value of early disease detection, including improving the quality of care and reducing medical costs. One of the cornerstones of early disease detection is clinically actionable predictions, where predictions are expected to be accurate, stable, real-time and interpretable. As an example, we used stroke-associated pneumonia (SAP), setting up a transformer-encoder-based model that analyzes highly heterogeneous electronic health records in real-time. The model was proven accurate and stable on an independent test set. In addition, it issued at least one warning for 98.6 % of SAP patients, and on average, its alerts were ahead of physician diagnoses by 2.71 days. We applied Integrated Gradient to glean the model's reasoning process. Supplementing the risk scores, the model highlighted critical historical events on patients' trajectories, which were shown to have high clinical relevance.
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Affiliation(s)
- Lutao Dai
- Faculty of Business and Economics, The University of Hong Kong, Hong Kong
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Center for Healthcare Quality and Research, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Center for Big Data Analytics and Artificial Intelligence, Beijing 100070, PR China
| | - Xingquan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China
| | - Lin Lin
- Information Management and Data Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Center for Big Data Analytics and Artificial Intelligence, Beijing 100070, PR China
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Center for Healthcare Quality and Research, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China; Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, PR China.
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases, Center for Healthcare Quality and Research, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China; Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, PR China; Chinese Institute for Brain Research, Beijing 100070, PR China.
| | - Haipeng Shen
- Faculty of Business and Economics, The University of Hong Kong, Hong Kong.
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12
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Konak HE, Alemdaroğlu E, Altaş EU. The relationship between dysphagia and the localisation of brain lesion in stroke: is the involvement of the pons and medulla important? Somatosens Mot Res 2024; 41:34-41. [PMID: 36625230 DOI: 10.1080/08990220.2023.2165058] [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: 06/06/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The presence of dysphagia in stroke is associated with mortality and morbidity. The aim of this retrospective study is to present the relationship between dysphagia and the demographic characteristics of the patient, and the type and localisation of brain lesion in the acute period in stroke patients with dysphagia. MATERIALS AND METHODS The data of 284 patients who had stroke-related dysphagia, had a disease duration 1-3 months, had no history of swallowing dysfunction before the event, and had their brain MRI/CT reports in the hospital were included. RESULTS The rate of tube-dependent oral areas was higher in the lesions located in the pons and the medulla than in the lesions located in the MCA cortex, the basal ganglia, and the cerebellum (p ˂ 0.001, p = 0.032 and p = 0.011, respectively) and the percentage of those fed with NG + TPN + PEG was statistically significantly higher (p = 0.002, p = 0.032 and p = 0.011, respectively). History of pneumonia was found to be statistically significantly higher in the lesions located in the pons and the medulla than in the lesions located in the MCA cortex, ACA cortex, PCA cortex, the basal ganglia, periventricular white matter, the thalamus, the cerebellum, and the midbrain (p ˂ 0.001, p = 0.005, p = 0.023, p ˂ 0.001, p = 0.023, p = 0.001, p = 0.011 and p = 0.023, respectively). CONCLUSION In conclusion, although lesion localisation in the acute period in patients with dysphagia varied in terms of clinical swallowing evaluation findings, weight loss, pneumonia history, the rate of tube-dependent intake, were shown to be higher in patients who had lesions in the pons and the medulla, which is a finding that should be considered in the clinical follow-up of acute stroke patients with lesions in the pons and the medulla.
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Affiliation(s)
- Hatice Ecem Konak
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ebru Alemdaroğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Elif Umay Altaş
- Ankara Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
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13
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Rabaneda-Lombarte N, Faura J, Ezcurra-Díaz G, Olivé-Gadea M, Álvarez-Larruy M, Vidal-de Francisco D, Domínguez-Mayoral A, Avellaneda C, Freijo MM, Zapata-Arriaza E, Serrano-Heras G, Alcahut-Rodríguez C, Fernández-Pérez I, Moniche F, Pérez-Sánchez S, Millán M, Rubiera M, Dorado L, Maisterra O, Montaner J, Bustamante A. Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy. Front Neurol 2024; 15:1358628. [PMID: 38497035 PMCID: PMC10941756 DOI: 10.3389/fneur.2024.1358628] [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: 12/20/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Objective The modified Centers for Disease Control and Prevention (mCDC) criteria have been proposed for diagnosing and managing stroke-associated pneumonia (SAP). The objective was to investigate the impact of SAP on stroke outcome depending on whether or not it conforms to mCDC criteria. Our secondary objective was to identify the responsible factors for antibiotic initiation in stroke patients. Methods We conducted a prospective, multicenter, observational study of ischemic stroke patients with moderate to severe stroke (NIHSS≥4) admitted within 24 h. For 7 days, mCDC criteria were assessed daily, and infections and antibiotics were recorded. Pneumonias were divided into those fulfilling mCDC criteria (mCDC-SAP) or not (other pneumonias, OPn). The effect of each type of pneumonia on 3-month outcome was evaluated in separated logistic regression models. Factors associated with antibiotic initiation were explored using a random forest analysis. Results Of the 342 patients studied, infections were diagnosed in 72 (21.6%), including 39 (11.7%) cases of pneumonia. Of them, 25 (7.5%) fulfilled mCDC criteria. Antibiotics were used in 92% of mCDC-SAP and 64.3% of OPn. In logistic regression analysis, mCDC-SAP, but not OPn, was an independent predictor of poor outcome [OR, 4.939 (1.022-23.868)]. The random forest analysis revealed that fever had the highest importance for antibiotic initiation. Interpretation The mCDC criteria might be useful for detecting clinically relevant SAP, which is associated with poor outcomes. Isolated signs of infection were more important for antibiotic initiation than compliance with pre-defined criteria. Therefore, adherence to mCDC criteria might result in antibiotic saving without compromising clinical outcome.
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Affiliation(s)
- Neus Rabaneda-Lombarte
- Hospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Júlia Faura
- Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - Garbiñe Ezcurra-Díaz
- Hospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Marta Álvarez-Larruy
- Hospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | | | | | | | | | | | | | | | | | | | - Mònica Millán
- Hospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Marta Rubiera
- Hospital Universitari Vall d’Hebrón, Barcelona, Spain
| | - Laura Dorado
- Hospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Joan Montaner
- Vall d'Hebrón Institute of Research, Barcelona, Spain
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Alejandro Bustamante
- Hospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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14
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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.
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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.
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15
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Deng YM, Sun JJ, Gu HQ, Yang KX, Wang YJ, Li ZX, Zhao XQ. Predictors of dysphagia screening and pneumonia among patients with intracerebral haemorrhage in China: a cross-sectional hospital-based retrospective study. BMJ Open 2024; 14:e073977. [PMID: 38238044 PMCID: PMC10806472 DOI: 10.1136/bmjopen-2023-073977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/19/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES This study aimed to investigate factors associated with undergoing dysphagia screening (DS) and developing pneumonia, as well as the relationship between DS and pneumonia in patients with intracerebral haemorrhage (ICH). DESIGN Our study was a cross-sectional hospital-based retrospective study. STUDY DESIGN AND SETTINGS We derived data from the China Stroke Centre Alliance, a nationwide clinical registry of ICH from 1476 participating hospitals in mainland China. To identify predictors for pneumonia, multivariable logistic regression models were used to identify patient characteristics that were independently associated with DS and pneumonia. PARTICIPANTS We included 31 546 patients in this study with patient characteristics, admission location, medical history, hospital characteristics and hospital grade from August 2015 to July 2019. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcomes were DS and pneumonia during acute hospitalisation. RESULTS In total, 25 749 (81.6%) and 7257 (23.0%) patients with ICH underwent DS and developed pneumonia. Compared with patients without pneumonia, those who developed pneumonia were older and had severe strokes (Glasgow Coma Scale 9-13: 52.7% vs 26.9%). Multivariable analyses revealed that a higher pneumonia risk was associated with dysphagia (OR, 4.34; 95% CI, 4.02 to 4.68), heart failure (OR, 1.85; 95% CI, 1.24 to 2.77) and smoking (OR, 1.12; 95% CI, 1.12 to 0.20). DS was associated with lower odds of pneumonia (OR, 0.65; 95% CI, 0.44 to 0.95). CONCLUSION Our findings further confirm that dysphagia is an independent risk factor for pneumonia; one-fifth of patients with ICH did not undergo DS. However, comprehensive dysphagia evaluation and effective management are crucial. Nursing processes ensure the collection of complete and accurate information during evaluation of patients. There is a need to increase the rate of DS in patients with ICH, especially those with severe stroke or older. Further, randomised controlled trials are warranted to determine the effectiveness of DS on clinical outcomes.
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Affiliation(s)
- Yong-Mei Deng
- Nursing Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Jin-Ju Sun
- Nursing Department, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research centre for Neurological Diseases, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research centre for Neurological Diseases, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research centre for Neurological Diseases, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Zi-Xiao Li
- China National Clinical Research centre for Neurological Diseases, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xing-Quan Zhao
- China National Clinical Research centre for Neurological Diseases, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
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16
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Elhefnawy M, Nazifah Sidek N, Maisharah Sheikh Ghadzi S, Ibrahim B, Looi I, Abdul Aziz Z, Noor Harun S. Prevalence of Stroke-Associated Pneumonia and Its Predictors Among Hyperglycaemia Patients During Acute Ischemic Stroke. Cureus 2024; 16:e52574. [PMID: 38371076 PMCID: PMC10874618 DOI: 10.7759/cureus.52574] [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: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Hyperglycaemia (HG) during an acute ischemic stroke (AIS) is not only associated with unfavourable functional outcomes but also associated with stroke-associated pneumonia (SAP). This study aimed to determine the prevalence of SAP among Malaysian patients with AIS and the predictors of SAP among patients with HG during AIS. METHODS This is a retrospective cross-sectional study that included patients with AIS admitted to Hospital Sultanah Nur Zahirah, Malaysia from 2017 to 2020. SAP was defined as infection with pneumonia during the first seven days after IS. HG was defined as a blood glucose level > 7.8 mmol/L within 72 h after admission. Patients with SAP were divided into two groups according to HG status. Multivariate logistic regression analysis was performed using SPSS software, version 22 (IBM Corp., Armonk, NY) to identify SAP predictors among patients with HG. Kaplan-Meier log-rank test was used to compare the survival rate from unfavourable functional outcomes between hyperglycaemic patients with and without SAP. RESULTS Among 412 patients with AIS, 69 (16.74%) had SAP. The prevalence of SAP among patients with HG and normoglycemia during AIS was 20.98%, and 10.65%, respectively. Age above 60 years, leucocytosis, and National Institute of Health Stroke Scale (NIHSS) > 14 on admission were independent predictors of SAP with aOR of 2.08 (95% CI;1.01-4.30), 2.83 (95% CI; 1.41-5.67), and 3.67 (95% CI; 1.53-8.80), respectively. No significant difference in unfavourable functional outcomes survival was found among patients with and without SAP (p = 0.653). CONCLUSION This study demonstrated the prevalence of SAP was higher among patients with HG compared to normoglycemia during AIS. The patient being old, leucocytosis and severe stroke upon admission predict the occurrence of SAP among patients with HG during AIS.
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Affiliation(s)
- Marwa Elhefnawy
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MYS
| | | | | | | | - Irene Looi
- Clinical Research Centre, Hospital Seberang Jaya, Seberang Jaya, MYS
| | - Zariah Abdul Aziz
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Terengganu, MYS
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17
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Krekeler BN, Yee J, Kurosu A, Osman F, Peña-Chávez R, Leverson G, Young B, Sattin J, Knigge M, Thibeault S, Rogus-Pulia N. Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial. Dysphagia 2023; 38:1551-1567. [PMID: 37195518 PMCID: PMC10615659 DOI: 10.1007/s00455-023-10583-0] [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: 11/16/2022] [Accepted: 04/21/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Swallowing impairments resulting from stroke have few rehabilitative options. Prior evidence suggests lingual strengthening exercise may provide some benefit, but more randomized controlled trials are required. The purpose of this study was to examine efficacy of progressive lingual resistance training on lingual pressure generative capacity and swallowing outcomes for individuals with dysphagia after stroke. METHODS Participants with dysphagia within 6 months of acute stroke were randomly assigned to: (1) treatment: progressive resistance tongue exercise using pressure sensors for 12 weeks with usual care; or (2) control: usual care only. Outcomes were measured at baseline, 8 and 12 weeks to assess group differences in lingual pressure generation, swallow safety, efficiency, oral intake, and swallowing quality of life. RESULTS Final sample included 19 participants [treatment (N = 9) and control (N = 10)] with 16 males and 3 females (mean age = 69.33). Functional Oral Intake Scale (FOIS) scores improved significantly (p = 0.04) in the treatment group from baseline to 8 weeks compared to usual care (control). No significant differences between treatment groups were identified for other outcomes; large effect sizes were detected for group differences in lingual pressure generative capacity from baseline to 8 weeks at the anterior sensor (d = .95) and posterior sensor (d = 0.96), and vallecular residue of liquids (baseline to 8-week d = 1.2). CONCLUSIONS Lingual strengthening exercise resulted in significant improvements in functional oral intake for patients with post-stroke dysphagia as compared to usual care after 8 weeks. Future studies should include a larger sample size and address treatment impact on specific aspects of swallow physiology.
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Affiliation(s)
- Brittany N Krekeler
- Department of Otolaryngology Head & Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Atsuko Kurosu
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Rodolfo Peña-Chávez
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
- Departamento de Ciencias de la Rehabilitación en Salud, Facultad de Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Concepción, Chile
| | - Glen Leverson
- Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Brittany Young
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Justin Sattin
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Molly Knigge
- Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Susan Thibeault
- Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA
| | - Nicole Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI, USA.
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison GRECC (11G), Room D4240, Madison, WI, 53705, USA.
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18
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Wang J, Wang Y, Wang P, Shen X, Wang L, He D. Construction and evaluation of a nomogram prediction model for aspiration pneumonia in patients with acute ischemic stroke. Heliyon 2023; 9:e22048. [PMID: 38034684 PMCID: PMC10682132 DOI: 10.1016/j.heliyon.2023.e22048] [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: 07/05/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background Aspiration Pneumonia (AP) is a leading cause of death in patients with Acute Ischemic Stroke (AIS). Early detection, diagnosis and effective prevention measures are crucial for improving patient prognosis. However, there is a lack of research predicting AP occurrence after AIS. This study aimed to identify risk factors and develop a nomogram model to determine the probability of developing AP after AIS. Method A total of 3258 AIS patients admitted to Jinshan Hospital of Fudan University between January 1, 2016, and August 20, 2022, were included. Among them, 307 patients were diagnosed with AP (AP group), while 2951 patients formed the control group (NAP group). Univariate and multivariate logistic regression analyses were conducted to identify relevant risk factors for AP after AIS. These factors were used to establish a scoring system and develop a nomogram model using R software. Results Univariate analysis revealed 20 factors significantly associated (P < 0.05) with the development of AP after AIS. These factors underwent multivariate logistic regression analysis, which identified age (elderly), National Institute of Health Stroke Scale (NIHSS) score, dysphagia, atrial fibrillation, cardiac insufficiency, renal insufficiency, hepatic insufficiency, elevated Fasting Blood Glucose (FBG), elevated C-Reactive Protein (CRP), elevated Neutrophil percentage (NEUT%), and decreased prealbumin as independent risk factors. A nomogram model incorporating these 11 risk factors was constructed, with a C-index of 0.872 (95 % CI: 0.845-0.899), indicating high accuracy. Calibration and clinical decision analyses demonstrated the model's reliability and clinical value. Conclusion A nomogram model incorporating age, NIHSS score, dysphagia, atrial fibrillation, cardiac insufficiency, renal insufficiency, hepatic insufficiency, FBG, CRP, NEUT%, and prealbumin effectively predicts AP risk in AIS patients. This model provides guidance for early intervention strategies, enabling the identification of high-risk individuals for timely preventive measures.
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Affiliation(s)
- Junming Wang
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, 201508, China
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, 201508, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, 201508, China
| | - Yuntao Wang
- Department of General Practice, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Pengfei Wang
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, 201508, China
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, 201508, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, 201508, China
| | - Xueting Shen
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Lina Wang
- Department of General Practice, Jinshan Hospital, Fudan University, Shanghai, 201508, China
| | - Daikun He
- Department of General Practice, Jinshan Hospital, Fudan University, Shanghai, 201508, China
- Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Center of Emergency and Critical Care Medicine, Jinshan Hospital, Fudan University, Shanghai, 201508, China
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, 201508, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, 201508, China
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Wang N, Wang X, Yang J, Bi T, Zhang S, Xu Y, Wang G, Jiang Y. Health Care-Associated Infection in Elderly Patients With Cerebrovascular Disease in Intensive Care Units: A Retrospective Cohort Study in Taizhou, China. World Neurosurg 2023; 178:e526-e532. [PMID: 37516147 DOI: 10.1016/j.wneu.2023.07.114] [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: 07/15/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Cerebrovascular diseases are associated with high incidence of health care-associated infections (HAIs) and poor prognosis in elderly patients. This study aimed to investigate the incidence and clinical characteristics of HAIs in elderly patients with cerebrovascular disease in the intensive care unit (ICU). METHODS Patients admitted with cerebrovascular disease, aged ≥65 years, were included. The clinical data of the patients were retrospectively analyzed to determine the risk factors, infection type, distribution, and pathogenic characteristics of HAIs in the context of cerebrovascular diseases. RESULTS Out of 381 ICU inpatients monitored, 79 (20.73%) developed HAIs. Risk analysis revealed number of ventilator days as significant risk factors for HAIs in elderly patients with cerebrovascular diseases in the comprehensive ICU. In the HAI group, 56 patients (70.89%) had respiratory tract infection (RTI). Sixty-five patients (82.28%) were infected with Gram-negative bacteria (GNB), and 42 (53.16%) with multi-drug-resistant organism (MDRO). The length of hospitalization days, ventilator days, and overall hospitalization costs were higher in the HAI group than in the non-HAI group (P < 0.05), but there was no significant difference between groups in the treatment outcome of patients. Patients with MDRO infection had longer duration and higher cost of hospitalization than those infected with non-MDRO (P < 0.05), but there was no significant difference between the groups in the treatment outcome of patients. CONCLUSIONS HAIs occurred mostly due to RTI and GNB infection. The hospitalization cost and duration, as well as the length of ventilator days, were higher for cerebrovascular patients with HAIs than for non-HAIs patients.
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Affiliation(s)
- Nan Wang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xiaoqiong Wang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jingjing Yang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tongxin Bi
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Sheng Zhang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yinghe Xu
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Gengge Wang
- Department of Hospital-Acquired Infection Control, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yongpo Jiang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
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20
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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.
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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.
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Gittins M, Lobo Chaves MA, Vail A, Smith CJ. Does stroke-associated pneumonia play an important role on risk of in-hospital mortality associated with severe stroke? A four-way decomposition analysis of a national cohort of stroke patients. Int J Stroke 2023; 18:1092-1101. [PMID: 37170807 PMCID: PMC10614175 DOI: 10.1177/17474930231177881] [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: 12/08/2022] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Severe strokes and stroke-associated pneumonia (SAP) have long been associated with poorer patient health outcomes, for example, in-hospital mortality. However, it is unclear what role SAP plays in the risk of in-hospital mortality associated with a severe stroke at admission. METHODS Using the Sentinel Stroke National Audit Program data on stroke admissions (2013-2018) in England and Wales, we modeled the "total" effect for severe stroke on risk of in-hospital mortality. Through four-way decomposition methodology, we broke down the "total" observed risk into four components. The direct "severity on outcome only" effect, the pure indirect effect of severity mediated via SAP only, the interaction between severity and SAP when mediation is not present, and when mediation via SAP is present. RESULTS Of 339,139 stroke patients included, 9.4% had SAP and 15.6% died in hospital. Of SAP patients, 45% died versus 12% of non-SAP patients. The risk ratio for in-hospital mortality associated with severe versus mild/moderate stroke (i.e. total effect) was 4.72 (95% confidence interval: 4.60-4.85). Of this, 43%-increased risk was due to additive SAP interaction, this increased to 50% for "very severe" stroke. The remaining excess relative risk was due to the direct severity on outcome effect only, that is, there was no evidence here for a mediation effect via SAP. CONCLUSION SAP was associated with a higher mortality in severe stroke patients. Prioritizing SAP prevention in severe stroke patients may improve in-hospital survival. Our results suggest that in severe stroke patients avoiding SAP might result in an up to 43% reduction in mortality.
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Affiliation(s)
- Matthew Gittins
- Centre for Biostatistics, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Marco Antonio Lobo Chaves
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
- GSK Biologicals, Wavre, Belgium
| | - Andy Vail
- Centre for Biostatistics, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Craig J Smith
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
- GSK Biologicals, Wavre, Belgium
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Li J, Luo H, Chen Y, Wu B, Han M, Jia W, Wu Y, Cheng R, Wang X, Ke J, Xian H, Liu J, Yu P, Tu J, Yi Y. Comparison of the Predictive Value of Inflammatory Biomarkers for the Risk of Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke. Clin Interv Aging 2023; 18:1477-1490. [PMID: 37720840 PMCID: PMC10503514 DOI: 10.2147/cia.s425393] [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: 07/06/2023] [Accepted: 09/03/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose To investigate the predictive value of various inflammatory biomarkers in patients with acute ischemic stroke (AIS) and evaluate the relationship between stroke-associated pneumonia (SAP) and the best predictive index. Patients and Methods We calculated the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), prognostic nutritional index (PNI), systemic inflammation response index (SIRI), systemic immune inflammation index (SII), Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS), and prognostic index (PI). Variables were selectively included in the logistic regression analysis to explore the associations of NLR, PLR, MLR, PNI, SIRI, SII, GPS, mGPS, and PI with SAP. We assessed the predictive performance of biomarkers by analyzing receiver operating characteristic (ROC) curves. We further used restricted cubic splines (RCS) to investigate the association. Next, we conducted subgroup analyses to investigate whether specific populations were more susceptible to NLR. Results NLR, PLR, MLR, SIRI, SII, GPS, mGPS, and PI increased significantly in SAP patients, and PNI was significantly decreased. After adjustment for potential confounders, the association of inflammatory biomarkers with SAP persisted. NLR showed the most favorable discriminative performance and was an independent risk factor predicting SAP. The RCS showed an increasing nonlinear trend of SAP risk with increasing NLR. The AUC of the combined indicator of NLR and C-reactive protein (CRP) was significantly higher than those of NLR and CRP alone (DeLong test, P<0.001). Subgroup analyses suggested good generalizability of the predictive effect. Conclusion NLR, PLR, MLR, PNI, SIRI, SII, GPS, mGPS, and PI can predict the occurrence of SAP. Among the indices, the NLR was the best predictor of SAP occurrence. It can therefore be used for the early identification of SAP.
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Affiliation(s)
- Jingyi Li
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Haowen Luo
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Yongsen Chen
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Bin Wu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Mengqi Han
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Weijie Jia
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Yifan Wu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Rui Cheng
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Xiaoman Wang
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Jingyao Ke
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - Hongfei Xian
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
- School of Public Health, Nanchang University, Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang, People’s Republic of China
| | - JianMo Liu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Pengfei Yu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Yingping Yi
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
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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.
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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
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Li Z, Gu M, Sun H, Chen X, Zhou J, Zhang Y. The Potential of Gut Microbiota in Prediction of Stroke-Associated Pneumonia. Brain Sci 2023; 13:1217. [PMID: 37626573 PMCID: PMC10452830 DOI: 10.3390/brainsci13081217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Stroke-associated pneumonia (SAP) is a common stroke complication, and the changes in the gut microbiota composition may play a role. Our study aimed to evaluate the predictive ability of gut microbiota for SAP. METHODS Acute ischemic stroke patients were prospectively enrolled and divided into two groups based on the presence or absence of SAP. The composition of gut microbiota was characterized by the 16S RNA Miseq sequencing. The gut microbiota that differed significantly between groups were incorporated into the conventional risk scores, the Acute Ischemic Stroke-Associated Pneumonia Score (AIS-APS), and the Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity Score (A2DS2). The predictive performances were assessed in terms of the area under the curve (AUC), the Net Reclassification Improvement (NRI), and the Integrated Discrimination Improvement (IDI) indices. RESULTS A total of 135 patients were enrolled, of whom 43 had SAP (31%). The short-chain fatty acids (SCFAs)-producing bacteria, such as Bacteroides, Fusicatenibacter, and Butyricicoccus, were decreased in the SAP group. The integrated models showed better predictive ability for SAP (AUC = 0.813, NRI = 0.333, p = 0.052, IDI = 0.038, p = 0.018, for AIS-APS; AUC = 0.816, NRI = 0.575, p < 0.001, IDI = 0.043, p = 0.007, for A2DS2) in comparison to the differential genera (AUC = 0.699) and each predictive score (AUCAISAPS = 0.777; AUCA2DS2 = 0.777). CONCLUSIONS The lower abundance of SCFAs-producing gut microbiota after acute ischemic stroke was associated with SAP and may play a role in SAP prediction.
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Affiliation(s)
- Zhongyuan Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing 210006, China; (Z.L.); (X.C.)
| | - Mengmeng Gu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing 210006, China; (Z.L.); (X.C.)
| | - Huanhuan Sun
- Department of Neurology, Nanjing Yuhua Hospital, Nanjing 210039, China
| | - Xiangliang Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing 210006, China; (Z.L.); (X.C.)
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing 210006, China; (Z.L.); (X.C.)
| | - Yingdong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No. 68, Changle Road, Nanjing 210006, China; (Z.L.); (X.C.)
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Sung LC, Chang CC, Yeh CC, Lee CY, Hu CJ, Cherng YG, Chen TL, Liao CC. The effects of regular dental scaling on the complications and mortality after stroke: a retrospective cohort study based on a real-world database. BMC Oral Health 2023; 23:487. [PMID: 37452324 PMCID: PMC10349500 DOI: 10.1186/s12903-023-03178-6] [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: 11/03/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Previous observational studies have shown that people with dental scaling (DS) had decreased risk of stroke. However, limited information is available on the association between DS and poststroke outcomes. The present study aimed to evaluate the effects of regular DS on the complications and mortality after stroke. METHODS We conducted a retrospective cohort study of 49,547 hospitalized stroke patients who received regular DS using 2010-2017 claims data of Taiwan's National Health Insurance. Using a propensity-score matching procedure, we selected 49,547 women without DS for comparison. Multiple logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of poststroke complications and in-hospital mortality associated with regular DS. RESULTS Stroke patients with regular DS had significantly lower risks of poststroke pneumonia (OR 0.58, 95% CI 0.54-0.63), septicemia (OR 0.58, 95% CI 0.54-0.63), urinary tract infection (OR 0.68, 95% CI 0.66-0.71), intensive care (OR 0.81, 95% CI 0.78-0.84), and in-hospital mortality (OR 0.66, 95% CI 0.62-0.71) compared with non-DS stroke patients. Stroke patients with regular DS also had shorter hospital stays (p < 0.0001) and less medical expenditures (p < 0.0001) during stroke admission than the control group. Lower rates of poststroke adverse events in patients with regular DS were noted in both sexes, all age groups, and people with various types of stroke. CONCLUSION Stroke patients with regular DS showed fewer complications and lower mortality compared with patients had no DS. These findings suggest the urgent need to promote regular DS for this susceptible population of stroke patients.
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Affiliation(s)
- Li-Chin Sung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, 11031, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, United States of America
| | - Chia-Yen Lee
- Department of Dentistry, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, 11031, Taiwan.
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
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Park D, Son SI, Kim MS, Kim TY, Choi JH, Lee SE, Hong D, Kim MC. Machine learning predictive model for aspiration screening in hospitalized patients with acute stroke. Sci Rep 2023; 13:7835. [PMID: 37188793 DOI: 10.1038/s41598-023-34999-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
Dysphagia is a fatal condition after acute stroke. We established machine learning (ML) models for screening aspiration in patients with acute stroke. This retrospective study enrolled patients with acute stroke admitted to a cerebrovascular specialty hospital between January 2016 and June 2022. A videofluoroscopic swallowing study (VFSS) confirmed aspiration. We evaluated the Gugging Swallowing Screen (GUSS), an early assessment tool for dysphagia, in all patients and compared its predictive value with ML models. Following ML algorithms were applied: regularized logistic regressions (ridge, lasso, and elastic net), random forest, extreme gradient boosting, support vector machines, k-nearest neighbors, and naïve Bayes. We finally analyzed data from 3408 patients, and 448 of them had aspiration on VFSS. The GUSS showed an area under the receiver operating characteristics curve (AUROC) of 0.79 (0.77-0.81). The ridge regression model was the best model among all ML models, with an AUROC of 0.81 (0.76-0.86), an F1 measure of 0.45. Regularized logistic regression models exhibited higher sensitivity (0.66-0.72) than the GUSS (0.64). Feature importance analyses revealed that the modified Rankin scale was the most important feature of ML performance. The proposed ML prediction models are valid and practical for screening aspiration in patients with acute stroke.
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Affiliation(s)
- Dougho Park
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, Republic of Korea.
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea.
| | - Seok Il Son
- Occupational Therapy Department of Rehabilitation Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Min Sol Kim
- Occupational Therapy Department of Rehabilitation Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Tae Yeon Kim
- Speech-Language Therapy Department of Rehabilitation Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Jun Hwa Choi
- Department of Quality Improvement, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Sang-Eok Lee
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Daeyoung Hong
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Mun-Chul Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
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Marin S, Ortega O, Serra-Prat M, Valls E, Pérez-Cordón L, Clavé P. Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review. Nutrients 2023; 15:nu15071714. [PMID: 37049553 PMCID: PMC10097035 DOI: 10.3390/nu15071714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management. Methods: A systematic review was conducted following PRISMA recommendations. Four databases were searched from inception through 30 June 2021. Outcome measures were cost-effectiveness and cost-savings of healthcare interventions. English and Spanish literature were included. Narrative and tables were used to present and synthesise evidence. Quality was evaluated using the CHEERS Statement. Results: A total of 244 studies were identified, and 10 were included. Screening and diagnosis of PS-OD studies found: (1) adjusted reduction in hospitalisation costs when assessed during the first admission day; (2) non-significant reduction in hospitalisation costs with OD management after thrombolysis; and (3) videofluoroscopy as the most cost-effective screening method (compared to bedside evaluation and a combination of both). Two studies showed cost-effective rehabilitation programmes, including OD management. Pelczarska et al. showed an incremental cost–utility ratio of texture-modified diets using a gum-based thickener of 20,977 PLN (4660€) following a dynamic model, and Kotecki et al. commercially prepared thickened fluids that were 44% to 59% less expensive than in situ prepared fluids. Elia et al. showed home enteral nutrition was cost-effective (£12,817/QALY), and Beavan et al. showed higher nutrient intake and low increase in hospitalisation costs using looped-nasogastric tubes (£5.20 for every 1% increase). Heterogeneity between studies precluded a quantitative synthesis. Conclusions: Included studies suggest that healthcare interventions aiming to prevent OD complications are cost-effective. However, studies assessing novel strategies are needed.
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Affiliation(s)
- Sergio Marin
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
- Neurogastroenterology and Motility Research Group, Institut de Recerca Germans Trias I Pujol, 08916 Badalona, Spain
- Correspondence: ; Tel.: +34-93-741-77-00
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Neurogastroenterology and Motility Research Group, Institut de Recerca Germans Trias I Pujol, 08916 Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08340 Mataró, Spain
| | - Mateu Serra-Prat
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08340 Mataró, Spain
- Research Unit, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Ester Valls
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Laia Pérez-Cordón
- Pharmacy Department, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Neurogastroenterology and Motility Research Group, Institut de Recerca Germans Trias I Pujol, 08916 Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08340 Mataró, Spain
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Cimini C, Moreau S. Management of Aspiration Risk in Stroke. Crit Care Nurs Clin North Am 2023; 35:17-29. [PMID: 36774004 DOI: 10.1016/j.cnc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Managing risk for aspiration in the stroke patient will assist to decrease one of the major complications that these patients experience, which is poststroke pneumonia. Using an evidenced-based dysphagia protocol is shown to reduce mortality, morbidity, and length of stay caused by poststroke pneumonia. Physicians, nurses, speech pathologists, and dieticians will be instrumental in performing ongoing assessments and aspiration-prevention strategies to improve stroke patient outcome and reduce complications. Education, and measurement of comprehension, of the care team, patient, and family concerning dysphagia management and prevention of aspiration pneumonia will assist in achieving the aforementioned goals.
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Affiliation(s)
- Cynthia Cimini
- Rapides Regional Medical Center, 211 Fourth Street, Alexandria, LA 71301, USA.
| | - Shawn Moreau
- Rapides Regional Medical Center, 211 Fourth Street, Alexandria, LA 71301, USA
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Ornello R, Colangeli E, Ceccanti G, Mammarella L, Desideri G, Sacco S. Reduction of in-hospital non-COVID-19 pneumonia in stroke patients during the COVID-19 pandemic. Neurol Sci 2023; 44:1849-1853. [PMID: 36853571 PMCID: PMC9973234 DOI: 10.1007/s10072-023-06712-0] [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: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Measures adopted to contain the spread of SARS-CoV-2 could have led to a reduction in the rate of non-COVID-19 infections. We assessed whether a similar reduction was present in patients with stroke. METHODS We performed a hospital-based study nested in a prospective population-based registry. We compared prevalence of infections and in-hospital mortality in subjects admitted for acute stroke between the first pandemic year (study period, from March 2020 to February 2021) and the pre-pandemic year (control period, from March 2019 to February 2020). Infections were reported as pneumonia (PNA), urinary tract infections (UTI), and any infection (INF). RESULTS From the control (n = 677) to the study period (n = 520), the prevalence of INF decreased from 11.5 to 4.6% (p < 0.001) and that of PNA decreased from 6.9 to 2.5% (p = 0.001). No changes in in-hospital mortality and length of hospital stay were observed between the two periods. CONCLUSIONS The observed reduction of in-hospital pneumonias in patients with stroke was likely attributable to the use of protective measures and limitation of hospital visits. Maintaining some of those measures in the long term may contribute to control infections in hospitalized patients with stroke.
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Affiliation(s)
- Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio 1 Coppito, 67100 L’Aquila, Italy
| | - Enrico Colangeli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio 1 Coppito, 67100 L’Aquila, Italy
| | - Giulia Ceccanti
- Department of Emergency Medicine, Ospedale “Felice Lotti”, Pontedera, Italy
| | - Leondino Mammarella
- Servizio Flussi Informativi E Statistica Sanitaria, ASL 1 Abruzzo, Avezzano, L’Aquila Italy
| | - Giovambattista Desideri
- Department of Internal Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1 Coppito, 67100, L'Aquila, Italy.
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Xie M, Yuan K, Zhu X, Chen J, Zhang X, Xie Y, Wu M, Wang Z, Liu R, Liu X. Systemic Immune-Inflammation Index and Long-Term Mortality in Patients with Stroke-Associated Pneumonia. J Inflamm Res 2023; 16:1581-1593. [PMID: 37092129 PMCID: PMC10120842 DOI: 10.2147/jir.s399371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 04/25/2023] Open
Abstract
Background Systemic immune inflammation has been investigated as a prognostic marker of different diseases. This study is designed to assess the association of systemic immune-inflammation index (SII) with long-term mortality of stroke-associated pneumonia (SAP) patients. Methods Patients aged ≥18 years with SAP were selected from the Nanjing Stroke Registry Program in China. We retrospectively evaluated systemic immune-inflammation response with SII and pneumonia severity with the pneumonia severity index and the confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older score. To explore the correlation between SII and mortality in SAP patients, multivariable Cox regressions and competing risk regressions were conducted. Mediation analysis was also performed to assess the role of pneumonia severity. Results Among 611 patients in the SAP population, death occurred in 164 patients (26.8%) during the median follow-up of 3.0 (1.2-4.6) years. In multivariate analysis, higher SII scores could predict increased mortality in patients with SAP (adjusted hazard ratio 2.061; 95% confidence interval, 1.256-3.383; P = 0.004), and the association was mediated by pneumonia severity. Moreover, adding SII to traditional models improved their predictive ability for mortality. Conclusion Our study displayed that SII was characterized in SAP patients with different prognoses. Elevated SII scores increased the risk of mortality. Further research is required for the clinical practice of the index among SAP patients.
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Affiliation(s)
- Mengdi Xie
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Kang Yuan
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Xinyi Zhu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Jingjing Chen
- Department of Neurology, Changhai Hospital, Navy Medical University, Shanghai, People’s Republic of China
| | - Xiaohao Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yi Xie
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Min Wu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Zhaojun Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Rui Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
- Rui Liu, Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210000, Jiangsu Province, People’s Republic of China, Tel +86 2584801861, Fax +86 2584805169, Email
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
- Correspondence: Xinfeng Liu, Department of Neurology, Jinling Hospital, Nanjing Medical University, No. 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210000, People’s Republic of China, Tel +86 2584801861, Fax +86 2584805169, Email
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Lu P, Cao Z, Gu H, Li Z, Wang Y, Cui L, Wang Y, Zhao X. Association of sex and age with in-hospital mortality and complications of patients with intracerebral hemorrhage: A study from the Chinese Stroke Center Alliance. Brain Behav 2023; 13:e2846. [PMID: 36495127 PMCID: PMC9847591 DOI: 10.1002/brb3.2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/06/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE The impact of sex and age on prognosis in patients with intracerebral hemorrhage (ICH) in the Chinese population remains unclear. Our study aimed to investigate the relationship between sex and age of Chinese ICH patients and adverse prognosis. METHODS We used the Chinese Stroke Center Alliance database with in-hospital mortality as the primary outcome and hospital complications as the secondary outcome. Patients were divided into four groups by sex and age. Logistic regression analyses were performed to assess the association between sex and age and the prognosis of ICH patients. RESULTS We enrolled 60,911 ICH patients, including 22,284 young and middle-aged males, 15,651 older males, 11,948 young and middle-aged females, and 11,028 older females. After adjusting for variables, older male patients had a higher mortality rate (OR = 1.21, 95% CI 1.01-1.45), combined with more frequent hematoma expansion (OR = 1.14, 95% CI 1.03-1.26), pneumonia (OR = 1.91, 95% CI 1.81-2.03), and hydrocephalus (OR = 1.28, 95% CI 1.04-1.59). Young and middle-aged female patients had a lower mortality rate (OR = 0.74, 95% CI 0.58-0.95) and less frequent combined pneumonia (OR = 0.81, 95% CI 0.75-0.87). In-hospital mortality was not significantly different in older females compared with young and middle-aged males, but the odds of deep vein thrombosis, swallowing disorders, urinary tract infections, and gastrointestinal bleeding were significantly higher. CONCLUSION Among young and middle-aged patients, females are related to a lower in-hospital mortality rate from ICH. Older patients are at an increased risk of ICH complications, with higher in-hospital mortality in older men.
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Affiliation(s)
- Ping Lu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhentang Cao
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China
| | - Yu Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lingyun Cui
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Park HY, Hwang UJ, Kwon OY. Correlation between trunk rotation and lateral flexion range of motion, peak cough flow, and chest expansion in stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e1970. [PMID: 35962597 DOI: 10.1002/pri.1970] [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: 02/01/2022] [Revised: 05/28/2022] [Accepted: 07/21/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Stroke patients have problems with voluntary movement and trunk control. Moreover, the respiratory function in stroke patients is affected by neurological impairment, which increases the incidence of respiratory complications. OBJECTIVES To determine the correlation between trunk rotation range of motion (TRROM) and trunk lateral flexion range of motion (TLFROM), peak cough flow (PCF), and chest expansion in stroke patients. METHODS This was an observational study involving 21 patients with a clinical diagnosis of stroke from October 2021 to January 2022. TRROM and TLFROM were assessed using smartphone applications (Compass and Clinometer), respectively, PCF was assessed using a peak flow meter, and chest expansion was assessed using a tape measure. Pearson's correlation was used to analyze the relationships between the variables. RESULTS Statistically significant correlations were found between TRROM and TLFROM (r = 0.91, p < 0.01) and between upper chest expansion and PCF (r = 0.59, p < 0.01). There were significant correlations between lower chest expansion and TRROM (r = 0.50, p < 0.05) and between lower chest expansion and TLFROM (r = 0.51, p < 0.05). CONCLUSION This study demonstrates the relationship between upper chest expansion and PCF. Upper chest expansion exercises should be considered to improve the PCF in stroke patients. In addition, a very strong positive correlation between TRROM and TLFROM was demonstrated. TRROM and TLFROM exercises should be considered to improve the lower chest expansion in stroke patients.
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Affiliation(s)
- Hee-Yong Park
- Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Korea
| | - Ui-Jae Hwang
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea.,Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea.,Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea
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He Y, Chen S, Chen Y. Analysis of Hospitalization Costs in Patients Suffering from Cerebral Infarction along with Varied Comorbidities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15053. [PMID: 36429773 PMCID: PMC9690305 DOI: 10.3390/ijerph192215053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study aimed to study the influence of comorbidities on hospitalization costs for inpatients with cerebral infarction. METHODS The data from the medical records pertaining to 76,563 inpatients diagnosed with cerebral infarction were collected from public hospital records for the period between 1 January 2020 and 30 December 2020 in Gansu Province. EpiData 3.1 software was used for data collation, and SPSS 25.0 was used for data analysis. Numbers and percentages were calculated for categorical variables, the chi-squared test was used to compare differences between groups, and multiple independent-sample tests (Kruskal-Wallis H test, test level α = 0.05) and multiple linear regression were used to analyze the influence of different types of comorbidity on hospitalization costs. RESULTS Among the 76,563 cerebral infarction inpatients, 41,400 were male (54.07%); the average age of the inpatients was 67.68 ± 10.75 years (the 60~80-year-old group accounted for 65.69%). Regarding the incidence of varied chronic disease comorbidities concomitant with cerebral infarction, hypertension was reported as the most frequent, followed by heart disease and chronic pulmonary disease. The average hospitalization cost of cerebral infarction inpatients is US $1219.66; the hospitalization cost increases according to the number of comorbidities with which a patient suffers (H = 404.506, p < 0.001); Regarding the types of comorbidities, the hospitalization cost of cancer was the highest, at US $1934.02, followed by chronic pulmonary disease (US $1533.02). Regarding the cost of hospitalization for combinations of comorbidities, cerebral infarction + chronic pulmonary disease was the most costly (US $1718.90), followed by cerebral infarction + hypertension + chronic pulmonary disease (US $1530.60). In the results of multiple linear regression analysis, cerebral infarction with chronic pulmonary disease had significant effects on hospitalization costs (β = 0.181, p < 0.001), drug costs (β = 0.144, p < 0.001) and diagnosis costs (β = 0.171, p < 0.001). CONCLUSIONS Comorbidities are significantly associated with high hospitalization costs for cerebral infarction patients. Furthermore, relevant health departments should build preventative and control systems to reduce the risk of comorbidities, as well as to improve hospital clinical pathway management and to strengthen and refine the cost-control management of cerebral infarction from the perspective of comorbidities.
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Guo F, Fan Q, Liu X, Sun D. Patient's care bundle benefits to prevent stroke associated pneumonia: A meta-analysis with trial sequential analysis. Front Neurol 2022; 13:950662. [DOI: 10.3389/fneur.2022.950662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatient's care bundle has been found to have a beneficial effect on refractory diseases, but the preventive effect of this strategy on stroke-associated pneumonia (SAP) remains unclear. The purpose of this meta-analysis was to determine the role of the patient's care bundle in the prevention of SAP.MethodsA systematic search was conducted in five electronic databases to identify randomized controlled trials (RCTs) published before January 31, 2022. The incidence of SAP and aspiration and the length of hospital stay were assessed. Random pair-wise meta-analysis was conducted using Review Manager 5.4, and trial sequential analysis (TSA) was also performed.ResultsTwenty eligible RCTs involving 1916 patients were included for data analysis. Pooled results suggested that patient's care bundle was associated with significantly lower incidence of SAP (risk ratio [RR], 0.37; 95% CI, 0.29–0.46; p < 0.001; I2 = 0%) and aspiration (RR, 0.23; 95% CI, 0.15–0.35; p < 0.001; I2 = 0%). Meanwhile, patient's care bundle also significantly shortened the length of hospital stay for general patients (mean difference [MD], −3.10; 95% CI, −3.83 to −2.37; p < 0.001; I2 = 16%) and the length of intensive care unit (ICU) stay for patients with severe stoke (MD, −4.85; 95% CI, −5.86−3.84; p < 0.001; I2 = 0%). Results of TSA confirmed that none of the findings could be significantly reversed by future studies.ConclusionsThe patient's care bundle effectively prevents the occurrence of SAP and aspiration and shortens the hospital stay of stroke patients. However, it is necessary to design more high-quality studies to further validate our findings and investigate their applicability in other geographical regions.
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Huppertz VAL, Pilz W, Pilz Da Cunha G, de Groot LCPGM, van Helvoort A, Schols JMGA, Baijens LWJ. Malnutrition risk and oropharyngeal dysphagia in the chronic post-stroke phase. Front Neurol 2022; 13:939735. [PMID: 36247786 PMCID: PMC9554502 DOI: 10.3389/fneur.2022.939735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Oropharyngeal dysphagia (OD) and malnutrition are associated with poor clinical outcomes after stroke. The present study evaluated (1) malnutrition risk and OD-related characteristics in patients with chronic post-stroke OD, and (2) the relationship between on the one hand OD severity and on the other hand functional oral intake and dysphagia-specific quality of life. Methods A cross-sectional study was conducted in a Dutch interdisciplinary outpatient clinic for OD. The standardized examination protocol comprised: clinical ear, nose, and throat examination, body mass index, the short nutritional assessment questionnaire (SNAQ), a standardized fiberoptic endoscopic evaluation of swallowing (FEES), the functional oral intake scale (FOIS), and the MD Anderson dysphagia inventory (MDADI). Results Forty-two consecutive patients with chronic post-stroke OD were included. Mean (±SD) age and BMI of the population were 69.1 (±8.7) years and 26.8 (±4.1) kg/m2 respectively. Seventeen (40.4%) patients presented a moderate to high risk of malnutrition (SNAQ score≥2). The FEES examination showed moderate to severe OD in 28 (66.7%) patients. The severity of OD was significantly related to the FOIS score but not to the MDADI scores. Conclusion In this specific sample of referred stroke patients, moderate to severe OD and moderate to high risk of malnutrition were common. Despite the use of clinical practice guidelines on stroke and a normal nutritional status at first sight, repeated screening for malnutrition and monitoring the severity and management of OD remain important elements in the care of patients with chronic post-stroke OD.
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Affiliation(s)
- V. A. L. Huppertz
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - W. Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, Netherlands
| | - G. Pilz Da Cunha
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - L. C. P. G. M. de Groot
- Division of Human Nutrition and Health, Wageningen University and Research Centre, Wageningen, Netherlands
| | - A. van Helvoort
- Department of Respiratory Medicine, Maastricht University, Maastricht, Netherlands
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
- Danone Nutricia Research, Utrecht, Netherlands
| | - J. M. G. A. Schols
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, Netherlands
| | - L. W. J. Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
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McCulloch L, Mouat IC, South K, McColl BW, Allan SM, Smith CJ. Stroke-induced changes to immune function and their relevance to increased risk of severe COVID-19 disease. DISCOVERY IMMUNOLOGY 2022; 1:kyac004. [PMID: 38566903 PMCID: PMC10917238 DOI: 10.1093/discim/kyac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 04/04/2024]
Abstract
As the COVID-19 pandemic moves towards endemic disease, it remains of key importance to identify groups of individuals vulnerable to severe infection and understand the biological factors that mediate this risk. Stroke patients are at increased risk of developing severe COVID-19, likely due to stroke-induced alterations to systemic immune function. Furthermore, immune responses associated with severe COVID-19 in patients without a history of stroke parallel many of the immune alterations induced by stroke, possibly resulting in a compounding effect that contributes to worsened disease severity. In this review, we discuss the changes to systemic immune function that likely contribute to augmented COVID-19 severity in patients with a history of stroke and the effects of COVID-19 on the immune system that may exacerbate these effects.
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Affiliation(s)
- Laura McCulloch
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Isobel C Mouat
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Kieron South
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Barry W McColl
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Stuart M Allan
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Craig J Smith
- Lydia Becker Institute of Immunology and Inflammation, Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
- Greater Manchester Comprehensive Stroke Centre, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
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Li X, Yu J, Shu C. Bibliometric analysis of global research trends on post-stroke pneumonia: Current development status and research Frontiers. Front Public Health 2022; 10:950859. [PMID: 35983361 PMCID: PMC9379091 DOI: 10.3389/fpubh.2022.950859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/11/2022] [Indexed: 01/03/2023] Open
Abstract
Background As one of the most common complications of stroke, post-stroke pneumonia significantly increases the incidence of adverse outcomes, mortality, and healthcare costs for patients with stroke. As the field of post-stroke pneumonia has gained interest in the recent years, there has been an increasing number of publications on post-stroke pneumonia research worldwide. Therefore, a more comprehensive understanding of the field is needed now. This paper is intended to analyze the research status and detect the research frontiers in this field. Methods VOS viewer, CiteSpace, and the online scientometric platform (https://bibliometric.com/) were the main visualization tools used in this paper. They were used to perform citation analysis of countries/institutions, co-citation analysis of authors/journals/references, co-authorship analysis of authors, co-occurrence analysis of keywords, and citation bursts analysis of references. Results The number of publications in this field has increased rapidly since 2010 and is expected to continue to increase in the next few years. The countries contributing most to post-stroke pneumonia research were the USA, China, and Germany. The most productive institution was Harvard University, followed by Humboldt University of Berlin, Charité Universitätsmedizin Berlin, and Free University of Berlin from Germany. Meanwhile, the German authors Meisel A, Meisel C, and Dirnagl U, who have contributed significantly to this field, were all associated with these three German institutions. The high-quality and high output journal was STROKE. In the coming years, the hot topic keywords “risk & risk-factors,” “outcome & impact,” “management & guidelines,” and “predictors” will gain more attention in this field. Finally, hot keywords were grouped into four clusters in this paper: cluster 1 (risk-factors studies of post-stroke pneumonia), cluster 2 (clinically relevant studies of post-stroke pneumonia), cluster 3 (mechanism studies of post-stroke pneumonia), and cluster 4 (care studies of post-stroke pneumonia). Conclusion This study shows the knowledge structure and evolution of the field of post-stroke pneumonia research and predicts research trends through visualization analysis. The future trend of post-stroke pneumonia research will gradually shift from clinical and mechanistic studies to treatment and prevention studies.
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Affiliation(s)
- Xiangfei Li
- School of Economics and Management, Tiangong University, Tianjin, China
| | - Jiahui Yu
- School of Economics and Management, Tiangong University, Tianjin, China
- *Correspondence: Jiahui Yu
| | - Chang Shu
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China
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Dai C, Yan D, Xu M, Huang Q, Ren W. Geriatric Nutritional Risk Index is related to the risk of stroke-associated pneumonia. Brain Behav 2022; 12:e2718. [PMID: 35849734 PMCID: PMC9392546 DOI: 10.1002/brb3.2718] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/12/2022] [Accepted: 07/07/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Stroke-associated pneumonia (SAP) occurs frequently after a stroke. Geriatric Nutritional Risk Index (GNRI) is a valuable indicator of elderly individuals' nutritional status. This research was designed to obtain insight into the link between GNRI and SAP. METHODS Patients with acute ischemic stroke (AIS) were categorized into the SAP and non-SAP groups. GNRI scores were divided into four layers: Q1, GNRI < 82; Q2, 82≤ GNRI < 92; Q3, 92≤ GNRI ≤98; Q4, GNRI > 98. To identify the independent risk and protective factors of developing SAP, logistic regression analyses were conducted. Additionally, we utilized the restricted cubic spline (RCS) analysis to test the effect of GNRI on the SAP risk. RESULTS The SAP group showed lower GNRI scores than the non-SAP group (96.88 ± 9.36 vs. 100.88 ± 8.25, p < 0.001). According to the logistic regression model, the Q1 and Q2 layers showed a higher risk of SAP than the Q3 layer, while the Q4 layer showed a lower SAP risk (all p < 0.05). Besides, the RCS model found that the risk of SAP dropped dramatically as GNRI scores increased, which got stable when the GNRI score was more significant than 100. CONCLUSION Lower GNRI scores were linked to a higher prevalence of SAP. In clinical practice, GNRI showed predictive value for SAP, which could be helpful in early SAP intervention and therapy.
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Affiliation(s)
- Caijun Dai
- Department of Pulmonary and Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Dan Yan
- Department of Pulmonary and Critical Care Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital, Jinhua, China
| | - Minjie Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiqi Huang
- Department of Cardiac Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenwei Ren
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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McCulloch L, Harris AJ, Malbon A, Daniels MJD, Younas M, Grainger JR, Allan SM, Smith CJ, McColl BW. Treatment with IgM-enriched intravenous immunoglobulins (IgM-IVIg) enhances clearance of stroke-associated bacterial lung infection. Immunol Suppl 2022; 167:558-575. [PMID: 35881080 DOI: 10.1111/imm.13553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
Post-stroke infection is a common complication of stroke that is associated with poor outcome. We previously reported that stroke induces an ablation of multiple sub-populations of B cells and reduces levels of IgM antibody, which coincides with the development of spontaneous bacterial pneumonia. The loss of IgM after stroke could be an important determinant of infection susceptibility and highlights this pathway as a target for intervention. We treated mice with a replacement dose of IgM-enriched intravenous immunoglobulin (IgM-IVIg) prior to and 24 h after middle cerebral artery occlusion (MCAO) and allowed them to recover for 2 d or 5 d post-surgery. Treatment with IgM-IVIg enhanced bacterial clearance from the lung after MCAO and improved lung pathology but did not impact brain infarct volume. IgM-IVIg treatment induced immunomodulatory effects systemically, including rescue of splenic plasma B cell numbers and endogenous mouse IgM and IgA circulating immunoglobulin concentrations that were reduced by MCAO. Treatment attenuated MCAO-induced elevation of selected pro-inflammatory cytokines in the lung. IgM-IVIg treatment did not increase the number of lung mononuclear phagocytes or directly modulate macrophage phagocytic capacity but enhanced phagocytosis of Staphylococcus aureus bioparticles in vitro. Low dose IgM-IVIg contributes to increased clearance of spontaneous lung bacteria after MCAO likely via increasing availability of antibody in the lung to enhance opsonophagocytic activity. Immunomodulatory effects of IgM-IVIg treatment may also contribute to reduced levels of damage in the lung after MCAO. IgM-IVIg shows promise as an antibacterial and immunomodulatory agent to use in the treatment of post-stroke infection.
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Affiliation(s)
- Laura McCulloch
- Centre for Inflammation Research, University of Edinburgh, Edinburgh
| | - Alison J Harris
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Alexandra Malbon
- Easter Bush Pathology, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, Midlothian
| | | | - Mehwish Younas
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester
| | - John R Grainger
- Lydia Becker Institute of Immunology and Inflammation, Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester
| | - Stuart M Allan
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester
| | - Craig J Smith
- Greater Manchester Comprehensive Stroke Centre, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford.,Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Group, University of Manchester, Manchester
| | - Barry W McColl
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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40
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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.
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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
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Ding Y, Ji Z, Liu Y, Niu J. Braden scale for predicting pneumonia after spontaneous intracerebral hemorrhage. Rev Assoc Med Bras (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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022] Open
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.
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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
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Wang J, Zhang J, Ye Y, Xu Q, Li Y, Feng S, Xiong X, Jian Z, Gu L. Peripheral Organ Injury After Stroke. Front Immunol 2022; 13:901209. [PMID: 35720359 PMCID: PMC9200619 DOI: 10.3389/fimmu.2022.901209] [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: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023] Open
Abstract
Stroke is a disease with high incidence, mortality and disability rates. It is also the main cause of adult disability in developed countries. Stroke is often caused by small emboli on the inner wall of the blood vessels supplying the brain, which can lead to arterial embolism, and can also be caused by cerebrovascular or thrombotic bleeding. With the exception of recombinant tissue plasminogen activator (rt-PA), which is a thrombolytic drug used to recanalize the occluded artery, most treatments have been demonstrated to be ineffective. Stroke can also induce peripheral organ damage. Most stroke patients have different degrees of injury to one or more organs, including the lung, heart, kidney, spleen, gastrointestinal tract and so on. In the acute phase of stroke, severe inflammation occurs in the brain, but there is strong immunosuppression in the peripheral organs, which greatly increases the risk of peripheral organ infection and aggravates organ damage. Nonneurological complications of stroke can affect treatment and prognosis, may cause serious short-term and long-term consequences and are associated with prolonged hospitalization and increased mortality. Many of these complications are preventable, and their adverse effects can be effectively mitigated by early detection and appropriate treatment with various medical measures. This article reviews the pathophysiological mechanism, clinical manifestations and treatment of peripheral organ injury after stroke.
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Affiliation(s)
- Jin Wang
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiehua Zhang
- Department of Stomatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yingze Ye
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingxue Xu
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yina Li
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shi Feng
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoxing Xiong
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhihong Jian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lijuan Gu
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
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Namasivayam-MacDonald AM, Ayub A, Najeeb H, Shune SE. Understanding the Independent Predictors of Dysphagia-Related Quality of Life in Stroke Survivors. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1697-1723. [PMID: 35344388 DOI: 10.1044/2022_jslhr-21-00502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE It is important to pinpoint modifiable factors contributing to reduced dysphagia-related quality of life (QoL) in order to improve treatment outcomes and patient health given that a large proportion of stroke survivors experience dysphagia. The purpose of this exploratory study was to identify the independent predictors of dysphagia-related QoL in community-dwelling stroke survivors. METHOD A sample of 31 adult stroke survivors with dysphagia (M age = 62 years; 23 males) and their partners (M age = 57 years; seven males) participated in the study. Survivors were > 3 months poststroke and living with their partner. Backward regression analysis methods were employed to determine independent predictors of dysphagia-related QoL using scores from the Swallowing-Related Quality of Life questionnaire. Independent variables tested included age, employment status, receiving dysphagia treatment, number of medical conditions, level of diet modification, Stroke Impact Scale (SIS) scores, relationship with partner, partner age, partner employment status, partner burden, and partner depression. RESULTS Results indicated that number of survivor medical conditions, degree of diet modification, SIS emotional subscale score, and partner employment status significantly predicted dysphagia-related QoL (p < .001). More specifically, stroke survivors with more medical conditions or a partner who worked outside of the home had worse dysphagia-related QoL, and those with better mental health or a less modified diet had better dysphagia-related QoL. CONCLUSION Factors related to dysphagia-related QoL are multifactorial and include both survivor and spousal variables. The results of this exploratory study highlight the need for clinicians and researchers to consider patient function and needs more wholistically to maximize perceived QoL.
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Affiliation(s)
| | - Aaliyeh Ayub
- California State University, Northridge
- Communication Disorders and Sciences Program, University of Oregon, Eugene
| | - Hiba Najeeb
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Samantha E Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
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Zhou J, Liu F, Zhou M, Long J, Zha F, Chen M, Li J, Yang Q, Zhang Z, Wang Y. Functional status and its related factors among stroke survivors in rehabilitation departments of hospitals in Shenzhen, China: a cross-sectional study. BMC Neurol 2022; 22:173. [PMID: 35546388 PMCID: PMC9092870 DOI: 10.1186/s12883-022-02696-0] [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: 12/28/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many stroke survivors have multiple chronic diseases and complications coupled with various other factors which may affect their functional status. We aimed to investigate the factors associated with poor functional status in hospitalized patients with stroke in Shenzhen, China. Methods In this cross-sectional study, four urban hospitals were selected using convenient sampling, and all stroke patients in these four hospitals were included using cluster sampling. The functional status of stroke survivors was evaluated using Longshi Scale. Explanatory variables (factors affecting functional status comprising age, sex, body mass index, smoking, alcohol consumption, complications, and chronic conditions) were collected. Ordinal logistic regression was used to examine which factors were associated with poor functional status. Results Stroke survivors with poor functional status accounted for 72.14% and were categorised as the bedridden group based on Longshi scale, 21.67% of patients with moderate functional limitation were categorised as the domestic group, and 6.19% of the patients with mild functional restriction were categorised as the community group. The highest dependence scores were noted for feeding (73.39%), bowel and bladder management (69.74%) and entertainment (69.53%) among the bedridden group, and housework (74.29%) among the domestic group. In the adjusted model, the odds of poor functional status were higher among stroke patients with older age (odds ratio [OR] = 2.39, 95% CI: 1.55–3.80), female sex (OR = 1.73, 95% CI: 1.08–2.77), duration of stroke more than 12 months (OR = 1.94, 95% CI: 1.28–2.95), with pulmonary infection (OR = 10.91, 95% CI: 5.81–20.50), and with deep venous thrombosis (OR = 3.00, 95% CI: 1.28–7.04). Conclusions Older adults (age ≥ 60 years) and women were more likely to exhibit poor functional status post-stroke. Pulmonary infection and deep venous thrombosis were related to an increased risk of being dependent on activities of daily living. Therefore, clinical and rehabilitation interventions aimed at preventing or treating these common complications should be addressed to deal with subsequent dysfunction post-stroke. Since all data were obtained in metropolitan areas where the economy is well developed, future studies should be conducted in rural areas and economically less developed cities. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02696-0.
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Affiliation(s)
- Jing Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Fang Liu
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Mingchao Zhou
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Jianjun Long
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Fubing Zha
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Miaoling Chen
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Jiehui Li
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Qingqing Yang
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Zeyu Zhang
- Shandong University of Traditional Chinese Medicine, Shandong Province, 4655 Daxue Road, Changqing District, Jinan, 250355, China
| | - Yulong Wang
- Department of Rehabilitation, the First Affiliated Hospital of Shenzhen University/Shenzhen Second People's Hospital, Guangdong Province, 3002 Sungang West Road, Futian District, Shenzhen, 518035, China.
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Prolonged Mechanical Ventilation: Outcomes and Management. J Clin Med 2022; 11:jcm11092451. [PMID: 35566577 PMCID: PMC9103623 DOI: 10.3390/jcm11092451] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/01/2023] Open
Abstract
The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, placing a burden on healthcare systems. Therefore, investigating the pathophysiology, risk factors, and treatment for PMV is crucial. Various underlying comorbidities have been associated with PMV. The pathophysiology of PMV includes the presence of an abnormal respiratory drive or ventilator-induced diaphragm dysfunction. Numerous studies have demonstrated that ventilator-induced diaphragm dysfunction is related to increases in in-hospital deaths, nosocomial pneumonia, oxidative stress, lung tissue hypoxia, ventilator dependence, and costs. Thus far, the pathophysiologic evidence for PMV has been derived from clinical human studies and experimental studies in animals. Moreover, recent studies have demonstrated the outcome benefits of pharmacological agents and rehabilitative programs for patients requiring PMV. However, methodological limitations affected these studies. Controlled prospective studies with an adequate number of participants are necessary to provide evidence of the mechanism, prognosis, and treatment of PMV. The great epidemiologic impact of PMV and the potential development of treatment make this a key research field.
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Effects of Transcranial Direct Durrent Stimulation on Post-stroke Dysphagia: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2022; 103:1436-1447. [PMID: 35337844 DOI: 10.1016/j.apmr.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This review aimed to systematically evaluate the effect of transcranial direct current stimulation (tDCS) on post-stroke dysphagia. DATA SOURCES PubMed, Cochrane Library (CENTRAL), Web of Science, VIP, CNKI, and Wanfang databases were systematically searched up to June 2021. STUDY SELECTION Randomized controlled trials (RCTs) on the effects of tDCS on post-stroke dysphagia DATA EXTRACTION: The extracted data included the author, country of publication, time of publication, key elements of bias risk assessment (such as randomized controlled trials and blind methods), sample size and basic information (age, course of disease, stroke location), intervention measures, treatment methods of tDCS (stimulation location, intensity, and duration), relevant outcome indicators, and relevant data (standard deviations).The Cochrane Risk of Bias Assessment Tool and PEDro Scale were used to assess the risk of bias. DATA SYNTHESIS Sixteen RCTs were included in this meta-analysis. Overall, the results revealed a large and statistically significant pooled effect size (0.80, CI 0.45-1.14; p<0.00001). The subgroup that explored the course of the disease yielded a large and significant effect size for the chronic phase group (0.80, CI 0.43-1.16; p<0.0001). For the stimulation intensity, 1 mA and 1.6 mA showed a moderate and significant effect sizes (0.47, CI 0.13-0.81; p=0.006 vs 1.39, CI 0.69-2.08; p<0.0001). In the subgroup analyses, the affected (0.87, CI 0.26-1.48; p=0.005) vs. unaffected (0.61, CI 0.23-0.99; p=0.002) hemisphere showed a significant result, and stimulation of the affected hemisphere had a more obvious effect. Subgroup analysis of stroke location showed that tDCS was effective for dysphagia after unilateral hemispheric stroke, bulbar paralysis, and brainstem stroke but not for dysphagia after ataxic and basal ganglia stroke. However, the subgroup analysis of stroke location revealed a significant result (0.81, CI 0.44-1.18; p<0.001). CONCLUSION This meta-analysis demonstrated the height and significant beneficial effect of tDCS on improving post-stroke dysphagia.
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Chang MC, Choo YJ, Seo KC, Yang S. The Relationship Between Dysphagia and Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:834240. [PMID: 35370927 PMCID: PMC8970315 DOI: 10.3389/fneur.2022.834240] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
BackgroundDysphagia is a common complication after stroke and is associated with the development of pneumonia. This study aimed to summarize the relationship between dysphagia and pneumonia in post-stroke patients.Materials and MethodsArticles published up to November 2021 were searched in the PubMed, Embase, Cochrane library, and Scopus databases. Studies that investigated the development of pneumonia in acute stroke patients with and without dysphagia were included. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies-of Interventions tool, and publication bias was evaluated using a funnel plot and Egger's test.ResultsOf 5,314 studies, five studies were included in the meta-analysis. The results revealed that the incidence of pneumonia was significantly higher in the dysphagia group than in the non-dysphagia group (OR 9.60; 95% CI 5.75–16.04; p < 0.0001; I2 = 78%). There was no significant difference in the mortality rate between the two groups (OR 5.64; 95% CI 0.83–38.18; p = 0.08; I2 = 99%).ConclusionDysphagia is a significant risk factor for pneumonia after stroke. The early diagnosis and treatment of dysphagia in stroke patients are important to prevent stroke-associated pneumonia.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Kyung Cheon Seo
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, School of Medicine, Ewha Womans University, Seoul, South Korea
- *Correspondence: Seoyon Yang
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Prust M, Saylor D, Zimba S, Sarfo FS, Shrestha GS, Berkowitz A, Vora N. Inpatient Management of Acute Stroke of Unknown Type in Resource-Limited Settings. Stroke 2022; 53:e108-e117. [PMID: 35045720 PMCID: PMC8885836 DOI: 10.1161/strokeaha.121.037297] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is the second leading cause of death and disability worldwide, with a disproportionate burden on low- and middle-income countries. Critical elements of guideline-based stroke care developed in high-income countries are not applicable to resource-limited settings, where lack of access to neuroimaging prevents clinicians from distinguishing between ischemic stroke and intracranial hemorrhage, requiring challenging clinical decision-making, particularly in the acute setting. We discuss strategies for acute inpatient management of stroke of unknown type with a focus on blood pressure management and antiplatelet therapy when neuroimaging is unavailable, and review some of the challenges and strategies for successfully implementing stroke unit care in resource-limited health care settings.
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Affiliation(s)
| | - Deanna Saylor
- Johns Hopkins University Hospital, Baltimore, MD, USA,University Teaching Hospital, Lusaka, Zambia
| | | | | | | | - Aaron Berkowitz
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Nirali Vora
- Stanford University Medical Center, Stanford, CA, USA
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Schaller-Paule MA, Foerch C, Bohmann FO, Lapa S, Misselwitz B, Kohlhase K, Rosenow F, Strzelczyk A, Willems LM. Predicting Poststroke Pneumonia in Patients With Anterior Large Vessel Occlusion: A Prospective, Population-Based Stroke Registry Analysis. Front Neurol 2022; 13:824450. [PMID: 35250827 PMCID: PMC8893016 DOI: 10.3389/fneur.2022.824450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To assess predictive factors for poststroke pneumonia (PSP) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) of the anterior circulation, with special regard to the impact of intravenous thrombolysis (IVT) and endovascular treatment (EVT) on the risk of PSP. As a secondary goal, the validity of the A2DS2, PNEUMONIA, and ISAN scores in LVO will be determined. Methods Analysis was based on consecutive data for the years 2017 to 2019 from the prospective inpatient stroke registry covering the entire federal state of Hesse, Germany, using the Kruskal-Wallis test and binary logistic regression. Results Data from 4,281 patients with LVO were included in the analysis (54.8% female, median age = 78 years, range = 18–102), of whom 66.4% (n = 2,843) received recanalization therapy (RCT). In total, 19.4% (n = 832) of all LVO patients developed PSP. Development of PSP was associated with an increase in overall in-hospital mortality of 32.1% compared with LVO patients without PSP (16.4%; p < 0.001). Incidence of PSP was increased in 2132 patients with either EVT (n = 928; 25.9% PSP incidence) or combined EVT plus IVT (n = 1,204; 24.1%), compared with 2,149 patients with IVT alone (n = 711; 15.2%) or conservative treatment only (n = 1,438; 13.5%; p < 0.001). Multivariate analysis identified EVT (OR 1.5) and combined EVT plus IVT (OR 1.5) as significant independent risk factors for PSP. Furthermore, male sex (OR 1.9), age ≥ 65 years (OR 1.7), dysphagia (OR 3.2) as well as impaired consciousness at arrival (OR 1.7) and the comorbidities diabetes (OR 1.4) and atrial fibrillation (OR 1.3) were significantly associated risk factors (each p < 0.001). Minor stroke (NIHSS ≤ 4) was associated with a significant lower risk of PSP (OR 0.5). Performance of risk stratification scores varied between A2DS2 (96.1% sensitivity, 20.7% specificity), PNEUMONIA (78.2% sensitivity and 45.1% specificity) and ISAN score (98.0% sensitivity, 20.0% specificity). Conclusion Nearly one in five stroke patients with LVO develops PSP during acute care. This risk of PSP is further increased if an EVT is performed. Other predictive factors are consistent with those previously described for all AIS patients. Available risk stratification scores proved to be sensitive tools in LVO patients but lack specificity.
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Affiliation(s)
- Martin A. Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- *Correspondence: Martin A. Schaller-Paule
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Ferdinand O. Bohmann
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Sriramya Lapa
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | | | - Konstantin Kohlhase
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Laurent M. Willems
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
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Hudák L, Nagy AC, Molnár S, Méhes G, Nagy KE, Oláh L, Csiba L. Discrepancies between clinical and autopsy findings in patients who had an acute stroke. Stroke Vasc Neurol 2022; 7:215-221. [PMID: 35101949 PMCID: PMC9240455 DOI: 10.1136/svn-2021-001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives According to international observations, the incidence of clinical autopsies is declining worldwide, plummeting below 5% in the USA and many European countries. It is an unfavourable trend as, in 7%–12% of cases, recent clinicopathological studies found discrepancies that might have changed the therapy or the outcome if known premortem. As previous large-scale observations have examined varied patient populations, we aimed to focus on the differences between the clinical and pathological diagnostic findings in only patients who had a stroke. Material and methods We assessed the postmortem non-neuropathological and neuropathological findings of 534 consecutive patients who had a stroke who passed away. Systemic neoplasms, pneumonias, thromboembolisms and haemorrhagic transformations revealed only by autopsy were considered severe abnormalities; in addition, benign abnormalities important from an educational or scientific point of view were also recorded. Results In 26 of the 534 cases (4.9%), the presence of systemic neoplasms had already been confirmed in the clinical stage; however, 8 (1.5%) malignant tumours were only detected during autopsy. Also, 80 (15%) thromboembolic events, 73 (13.6%) pneumonias and 66 (18%) haemorrhagic transformations were only diagnosed at autopsy. Longer hospital stay (from admission to death) resulted in fewer discrepancies between clinical and autopsy diagnosis of thromboembolic events and pneumonias (p<0.01). In 169 cases, benign findings were detected. Conclusions While the type of acute stroke is reliably diagnosed with imaging techniques, postmortem autopsies are also important in patients who had a stroke as autopsies may reveal clinically silent diseases (eg, tumour), and contribute to knowing the actual incidence of stroke-related thromboembolic and pneumonia complications.
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Affiliation(s)
- Lilla Hudák
- Department of Neurology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Attila Csaba Nagy
- Department of Preventive Medicine, University of Debrecen Faculty of Public Health, Debrecen, Hungary
| | - Sarolta Molnár
- Department of Pathology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Gábor Méhes
- Department of Pathology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Katalin Erzsébet Nagy
- Department of Neurology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - László Oláh
- Department of Neurology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
- Doctoral School of Neuroscience, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - László Csiba
- Department of Neurology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
- Doctoral School of Neuroscience, University of Debrecen Faculty of Medicine, Debrecen, Hungary
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