TY  - JOUR
A1  - Schaller-Paule, Martin A.
A1  - Förch, Christian
A1  - Bohmann, Ferdinand
A1  - Lapa, Sriramya
A1  - Misselwitz, Björn
A1  - Kohlhase, Konstantin David
A1  - Rosenow, Felix
A1  - Strzelczyk, Adam
A1  - Willems, Laurent
T1  - Predicting poststroke pneumonia in patients with anterior large vessel occlusion: a prospective, population-based stroke registry analysis
T2  - Frontiers in neurology
N2  - 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.
KW  - infection
KW  - mechanical recanalization
KW  - endovascular thrombectomy
KW  - thrombolysis
KW  - neurocritical care
KW  - alteplase
KW  - complication
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62047
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-620473
SN  - 1664-2295
N1  - Data Availability Statement
The data analyzed in this study is subject to the following licenses/restrictions: data will be made available after reasonable request due to German regulations on data protection. Requests to access these datasets should be directed to Martin A. Schaller-Paule, martin.schaller@kgu.de.
VL  - 13
IS  - art. 824450
SP  - 1
EP  - 9
PB  - Frontiers Research Foundation
CY  - Lausanne
ER  -