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ISSN 1727-897X (Electronic)

2022, Number 6

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Medisur 2022; 20 (6)

Creation and validation of a new index to predict pneumonia associated with ischemic stroke

Suárez QA, Álvarez AA, Quesada VAJ

Language: Spanish
References: 31
Page: 1040-1052
PDF size: 632.40 Kb.


ABSTRACT

Background: pneumonia associated with ischemic stroke is the medical complication with the greatest impact in this group of patients, as it increases the risk of recurrence, decreases functional recovery and triples the number of deaths.
Objective: to create and validate a new predictive index of pneumonia associated with ischemic stroke.
Methods 725 patients with a diagnosis of ischemic stroke, belonging to a prospective cohort, treated at the Carlos Manuel de Céspedes Provincial General Hospital in Bayamo, Granma province, were studied. The sample was randomly divided into a construction cohort with 509 patients for the creation of the index, and another validation cohort with 216 patients. A new quantitative index of four risk categories was obtained from the corresponding regression coefficients of each independent predictor.
Results: the variables that contributed the highest score to the index were dysphagia (28), the NIHSS scale ≥ 12 points (24) and heart failure (22). The new index presented good discriminative capacity (area under the ROC curve = 0.94). In the validation sample, it showed better discrimination capacity, greater validity and reliability when compared with the international A2DS2 and ISAN indices.
Conclusion: the new index created and validated allows to satisfactorily predict the development of pneumonia associated with ischemic stroke. It is a useful and safe tool for use in healthcare practice.


REFERENCES

  1. Vermeij JD, Westendorp WF, van de Beek D, Nederkoorn PJ. Post-stroke infections and preventive antibiotics in stroke: Update of clinical evidence. Int J Stroke. 2018;13(9): 913-20.

  2. Badve MS, Zhou Z, van de Beek D, Anderson CS, Hackett ML. Frequency of post-stroke pneumonia: Systematic review and meta-analysis of observational studies. Int J Stroke. 2019;14(2):125-36.

  3. Smith CJ, Kishore AK, Vail A, Chamorro A, Garau J, Hopkins SJ, et al. Diagnosis of Stroke-Associated Pneumonia: Recommendations From the Pneumonia in Stroke Consensus Group. Stroke. 2015;46(8):2335-40.

  4. Ji R, Shen H, Pan Y, Wang P, Liu G, Wang Y, et al; China National Stroke Registry Investigators. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke. 2013;44(5):1303-9.

  5. Smith CJ, Bray BD, Hoffman A, Meisel A, Heuschmann PU, Wolfe CD, et al; Intercollegiate Stroke Working Party Group. Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study. J Am Heart Assoc. 2015;4(1):e001307.

  6. Hoffmann S, Malzahn U, Harms H, Koennecke HC, Berger K, Kalic M, et al; Berlin Stroke Register and the Stroke Register of Northwest Germany. Development of a clinical score (A2DS2) to predict pneumonia in acute ischemic stroke. Stroke. 2012;43(10):2617-23.

  7. Huang J, Liu M, He W, Liu F, Cheng J, Wang H. Use of the A2DS2 scale to predict morbidity in stroke-associated pneumonia: a systematic review and meta-analysis. BMC Neurol. 2021;21(1):33.

  8. Tu TM, Phua SS, Acharyya S, Ng WM, Oh DC. Predicting Pneumonia in Acute Ischaemic Stroke: Comparison of Five Prediction Scoring Models. Ann Acad Med Singap. 2017;46(6):237-44.

  9. Jiao J, Geng L, Zhang Z. Do We Need to Distinguish Thrombolysis and Nonthrombolysis Patients When Applying Stroke-Associated Pneumonia Predicting Scores? An External Validation from a 2-Center Database. Med Sci Monit. 2020 Sep 14;26:e924129.

  10. Suárez A, Álvarez A, Quesada A, Pupo J. Factores asociados al desarrollo de la neumonía asociada al ictus isquémico. Medisur[Internet]. 2022[citado 02/10/2022];20(5):[aprox. 10p]. Disponible en: http://www.medisur.sld.cu/index.php/medisur/article/view/5476/388810.

  11. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al; American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Council on Nutrition, Physical Activity and Metabolism. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89.

  12. Saitoh E, Pongpipatpaiboon K, Inamoto Y, Kagaya H. Dysphagia Evaluation and Treatment: From the Perspective of Rehabilitation Medicine. Singapore: Springer; 2018.

  13. Díez E, del Brutto O, Alvarez J, Muñoz M, Abiusi G; Sociedad Iberoamericana de Enfermedades Cerebrovasculares. Clasificación de las enfermedades cerebrovasculares. Rev Neurol. 2001;33(5):455-64.

  14. Kishore AK, Vail A, Bray BD, Chamorro A, Napoli MD, Kalra L, et al. Clinical risk scores for predicting stroke-associated pneumonia: A systematic review. Eur Stroke J. 2016;1(2):76-84.

  15. Westendorp WF, Vermeij JD, Hilkens NA, Brouwer MC, Algra A, van der Worp HB, et al. Development and internal validation of a prediction rule for post-stroke infection and post-stroke pneumonia in acute stroke patients. Eur Stroke J. 2018;3(2):136-44.

  16. -Zapata E, Moniche F, Blanca PG, Bustamante A, Escudero I, Uclés O, et al. External Validation of the ISAN, A2DS2, and AIS-APS Scores for Predicting Stroke-Associated Pneumonia. J Stroke Cerebrovasc Dis. 2018;27(3):673-6.

  17. Helmy TA, Abd-Elhady MA, Abdou M. Prediction of Ischemic Stroke-Associated Pneumonia: A Comparison between 3 Scores. J Stroke Cerebrovasc Dis. 2016;25(11):2756-61.

  18. Ramírez JM, Martínez M, Cordova R, Roa AM, Constantino AB, Ceberino D, et al. Validación externa de las escalas A2DS2 e ISAN para predecir la infección respiratoria asociada al ictus isquémico. Neurología. 2019;34(1):14-21.

  19. Ni J, Shou W, Wu X, Sun J. Prediction of stroke-associated pneumonia by the A2DS2, AIS-APS, and ISAN scores: a systematic review and meta-analysis. Expert Rev Respir Med. 2021;15(11):1461-72.

  20. Zhang B, Zhao W, Wu C, Wu L, Hou C, Klomparens K, et al. SDL Index Predicts Stroke-Associated Pneumonia in Patients After Endovascular Therapy. Front Neurol. 2021;12:622272.

  21. Wang Y, Wu Z. The establishment of a stroke-associated pneumonia predictive scoring system. Neurol Asia. 2021;26(3): 485-90.

  22. Shi K, Wood K, Shi FD, Wang X, Liu Q. Stroke-induced immunosuppression and poststroke infection. Stroke Vasc Neurol. 2018;3(1):34-41.

  23. Liu DD, Chu SF, Chen C, Yang PF, Chen NH, He X. Research progress in stroke-induced immunodepression syndrome (SIDS) and stroke-associated pneumonia (SAP). Neurochem Int. 2018 114:42-54.

  24. Shim R, Wong CHY. Complex interplay of multiple biological systems that contribute to post-stroke infections. Brain Behav Immun. 2018;70:10-20.

  25. Kim E, Cho S. CNS and peripheral immunity in cerebral ischemia: partition and interaction. Exp Neurol. 2022;335:113508.

  26. Benarroch EE. Sistema nervioso autónomo e interacciones neuroinmunes. Nuevas visiones e implicancias clínicas. Neurology. 2019;92:377-85.

  27. Urra X, Chamorro A. Stroke-induced immunodepression is a marker of severe brain damage. Stroke. 2010;41(2):e110.

  28. Malone K, Amu S, Moore AC, Waeber C. Immunomodulatory therapeutic strategies in stroke. Front Pharmacol. 2019;10:1-21.

  29. Balch MHH, Nimjee SM, Rink C, Hannawi Y. Beyond the Brain: The Systemic Pathophysiological Response to Acute Ischemic Stroke. J Stroke. 2020;22(2):159-172.

  30. Huang Y, Wan C, Wu G. Acute kidney injury after a stroke: A PRISMA-compliant meta-analysis. Brain Behav. 2020;10(9):e01722.

  31. Arnold J, Ng KP, Sims D, Gill P, Cockwell P, Ferro C. Incidence and impact on outcomes of acute kidney injury after a stroke: a systematic review and meta-analysis. BMC Nephrol. 2018;19(1):1-10.




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