Risk factors for and impact of poststroke pneumonia in patients with acute ischemic stroke

The role of TyG index as a predictor of all-cause mortality in hospitalized patients with acute pancreatitis: a retrospective study utilizing the MIMIC-IV database

BACKGROUND

The TyG index is widely recognized as a reliable indicator for cardiovascular disease risk and as a biomarker for assessing insulin resistance(IR). However, its significance in the context of patients with acute pancreatitis(AP) needs further exploration. This study aimed to investigate the association between the TyG index and the risk of all-cause mortality in critically ill patients with AP.

METHODS

Data for this retrospective study were obtained from the MIMIC IV2.2 database. The participants were divided into four groups based on the TyG index tertiles. The primary outcome measured was in-hospital all-cause mortality. We employed Cox proportional hazards regression analysis and restricted cubic splines to evaluate the correlation between the TyG index and clinical outcomes in patients with AP.

RESULTS

The study included 586 patients, of which 44.71% were male. The rates of mortality observed in the hospital stay and in the ICU stay were 19.28% and 12.97%. By conducting multivariable Cox proportional hazards, it was determined that the TyG index was independently associated with a heightened risk of in-hospital mortality [HR(95%CI) of 1.38(1.03-1.87, P=0.033)] and in ICU mortality [1.65(1.12-2.44), P=0.012]. The analysis using restricted cubic splines showed that there was a consistent and gradually increasing risk of all-cause mortality as the TyG index increased. This indicates that a higher TyG index is associated with a higher risk of mortality.

CONCLUSION

In critically ill patients with AP, the TyG index shows a notable correlation with all-cause death in both hospital and ICU. The TyG index can be useful in identifying insulin resistance at an early stage in patients with AP, thereby improving risk assessment and guiding subsequent interventions.

Association Between Serum Uric Acid to High-Density Lipoprotein Cholesterol Ratio and Pneumonia After Endovascular Treatment of Vertebrobasilar Artery Occlusion

Background

The uric acid to high-density lipoprotein cholesterol ratio (UHR) is a novel marker of inflammation and metabolism. We aimed to explore the association of UHR with pneumonia after endovascular thrombectomy (EVT) in patients with vertebrobasilar artery occlusion (VBAO).

Methods

We retrospectively enrolled participants diagnosed with acute VBAO treated with EVT within 24 hours of estimated occlusion time from the multicenter PERSIST study. The primary outcome was pneumonia within 7 days after EVT according to the Pneumonia in Stroke Consensus Group recommendations. We utilized the restricted cubic spline curve to explore the dose-response relationship between UHR and pneumonia. We used multivariable logistic regression models to assess the association between UHR and the risk of pneumonia after EVT and verified the findings in subgroup analysis.

Results

Three hundred and seventy-eight patients were enrolled in this study, and 236 (62.4%) were diagnosed with pneumonia. In multivariable models, a higher UHR was associated with an increased risk of pneumonia after EVT (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.10; P = 0.020; tertile 3 versus tertile 1: OR, 2.09; 95% CI, 1.15-3.82; P = 0.016). The dose-response relationship indicated that UHR was linearly associated with the risk of pneumonia (P = 0.888). The association between UHR and pneumonia remained significant in different subgroups.

Conclusion

This study demonstrated that a higher UHR was associated with an increased risk of pneumonia in VABO patients treated with EVT. Further studies were warranted to verify the prognostic values of UHR in pneumonia after EVT.

Understanding definitive and probable stroke-associated pneumonia: Risk factors and clinical outcomes

OBJECTIVE

The aim of this study was to identify the risk factors for stroke-associated pneumonia (SAP), to investigate its impact on functional outcomes at discharge, and to examine the effect of white blood cell (WBC) count, C-reactive protein (CRP), and lymphocyte count on the development of SAP.

MATERIALS AND METHODS

This retrospective study included patients age ≥ 18 years, those presenting within the first 7 days of an acute ischemic and/or hemorrhagic stroke, having either first-time or recurrent incident between September 2018 and June 2019. The diagnosis of stroke was made based on clinical findings as evidenced by cranial computed tomography (CT) or magnetic resonance imaging (MRI). The classification of stroke was based on the International Classification of Diseases (ICD)-10. The Bamford Classification was used to identify ischemic stroke subtypes. The WBC and CRP levels were recorded at the time of admission and 24 h after admission. The clinical severity of the stroke was measured by the National Institutes of Health stroke scale (NIHSS) on the admission day. Functional outcome measures were the NIHSS and Modified Rankin Scale scores (mRS) at discharge.

RESULTS

A total of 481 patients who met the inclusion criteria were recruited. Of these, 82 (18.2 %) were diagnosed with pneumonia. While 78 patients had SAP, four were accepted as hospitalization-associated pneumonia (HAP). Fifty-two (11 %) patients were d-SAP. Overall, SAP and HAP occurred in 82 patients with a median latency from admission of 3.7 days. Definitive SAP developed in a median duration of 3 days, while p-SAP developed in a median duration of 4 days. Sputum cultures were performed in 123 patients, and most of the cultures were negative (75.6 %). The positive results contained Staphylococcus aureus, Proteus mirabilis, Haemophilus influenzae (5.7 %, 3.3 %, 2.4 %, respectively). The median NIHSS value was 16 (range, 3-23) in the d-SAP and 9.5 in p-SAP group (p < 0.001). The patients with d-SAP had poorer outcomes at the time of discharge, indicating a statistically significant difference (p < 0.001).

CONCLUSION

Our study results showed that d-SAP group had higher incidence of stroke severity, atrial fibrillation, lower ejection fraction value, and increased WBC level at the time of admission and follow-up. Poor functional outcome was highly related with definitive SAP. Lymphopenia was associated with pneumonia frequency, lesion size, and poor functional outcome.

Lower peak expiratory flow rate is associated with a higher risk of pneumonia in patients with stroke

BACKGROUND

Low peak expiratory flow (PEF) rate is common in patients with stroke. Studies on changes in PEF rates in patients with stroke often have small sample sizes, limiting the generalizability of their findings.

AIM

This study aimed to compare the PEF rates between patients who were post-stroke with or without pneumonia and age- and sex-matched healthy controls and explore the PEF-pneumonia association among stroke survivors.

DESIGN

Prospective observational study.

SETTING

Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University.

POPULATION

Initially, 809 patients with stroke undergoing inpatient rehabilitation were recruited.

METHODS

Data collected included the demographics, stroke history, the presence of dysphagia, and the PEF rates on admission. Logistic regression analysis was conducted to identify the PEF threshold as predictive of pneumonia after adjusting for confounders.

RESULTS

Patients with stroke had a mean PEF rate of 243.89±139.38 L/min, significantly lower than that of the normal control group. The PEF rate was significantly lower in the pneumonia group than in the non-pneumonia group (P<0.001). Within the stroke cohort, the PEF rates were lower than the predicted rates (P<0.001). Older age, lower PEF(%),and dysphagia were associated with a higher pneumonia risk post-stroke per stepwise multivariate logistic regression analysis. Furthermore, the combination of these three significant predictors (PEF(%), swallowing function, and age) yielded an area under the curve of 0.857 .Regarding age, the cut-off point of ≥65.5 years was the optimal level to discriminate the presence of pneumonia among patients with stroke. For PEF%,the cut-off point of <60% was the optimal level to discriminate the presence of pneumonia among patients with stroke. For screening dysphagia, the patients with impaired safety only and those with impaired safety and efficacy faced a higher pneumonia risk.

CONCLUSIONS

Patients with stroke exhibited significantly lower peak expiratory flow rates compared to healthy controls after adjusting for age and sex and when compared to their reference values. Decreased PEF rates were independently associated with pneumonia development during inpatient rehabilitation in post-stroke patients.

CLINICAL REHABILITATION IMPACT

This study suggests that low PEF rates may predict pneumonia and that the prevention of PEF rate decline may prevent pneumonia development.

Identification of risk factors and construction of a nomogram predictive model for post-stroke infection in patients with acute ischemic stroke

BACKGROUND

Post-stroke infection is the most common complication of stroke and poses a huge threat to patients. In addition to prolonging the hospitalization time and increasing the medical burden, post-stroke infection also significantly increases the risk of disease and death. Clarifying the risk factors for post-stroke infection in patients with acute ischemic stroke (AIS) is of great significance. It can guide clinical practice to perform corresponding prevention and control work early, minimizing the risk of stroke-related infections and ensuring favorable disease outcomes.

AIM

To explore the risk factors for post-stroke infection in patients with AIS and to construct a nomogram predictive model.

METHODS

The clinical data of 206 patients with AIS admitted to our hospital between April 2020 and April 2023 were retrospectively collected. Baseline data and post-stroke infection status of all study subjects were assessed, and the risk factors for post-stroke infection in patients with AIS were analyzed.

RESULTS

Totally, 48 patients with AIS developed stroke, with an infection rate of 23.3%. Age, diabetes, disturbance of consciousness, high National Institutes of Health Stroke Scale (NIHSS) score at admission, invasive operation, and chronic obstructive pulmonary disease (COPD) were risk factors for post-stroke infection in patients with AIS (P < 0.05). A nomogram prediction model was constructed with a C-index of 0.891, reflecting the good potential clinical efficacy of the nomogram prediction model. The calibration curve also showed good consistency between the actual observations and nomogram predictions. The area under the receiver operating characteristic curve was 0.891 (95% confidence interval: 0.839-0.942), showing predictive value for post-stroke infection. When the optimal cutoff value was selected, the sensitivity and specificity were 87.5% and 79.7%, respectively.

CONCLUSION

Age, diabetes, disturbance of consciousness, NIHSS score at admission, invasive surgery, and COPD are risk factors for post-stroke infection following AIS. The nomogram prediction model established based on these factors exhibits high discrimination and accuracy.

Stroke Phase Is Essential for Pneumonia in Dysphagia Patients After Cerebral Infarction

BACKGROUND

The risk of pneumonia increases after stroke, especially in poststroke dysphagia patients. Propensity score matching (PSM) is a statistical method in SPSS, which can be used to balance the difference between the 2 groups of known factors. Nasogastric tube feeding is an important factor of stroke-associated pneumonia. However, few studies have used PSM to eliminate the effect of confounding factor.

METHODS

Our research was a retrospective case-control study. Retrospective review of the patient database between December 1, 2019, and June 30, 2022, to identify consecutive dysphagia patients after cerebral infarction during hospitalization. An 1:1 PSM in SPSS 25.0 was used to balance nasogastric tube feeding between patients with and without pneumonia. The characteristics of these 2 groups were analyzed. Univariate and binary logistic regression analyses were used to screen the risk factors of dysphagia after cerebral infarction.

RESULTS

After 1:1 PSM, 198 subjects met our criteria and were included in the analysis. Age [odds ratio (OR)=1.047, 95% CI: 1.013-1.081, P =0.006], stroke phase (acute stroke) (OR=5.931, 95% CI: 1.133-31.054, P =0.035), admission National Institutes of Health Stroke Scale score (OR=1.058, 95% CI: 1.004-1.115, P =0.034), and length of hospital stay (OR=1.025, 95% CI: 1.001-1.049, P =0.042) had statistically significant correlation with pneumonia in patients with dysphagia after cerebral infarction.

CONCLUSION

In clinical practice, for the prevention of pneumonia in patients with dysphagia after cerebral infarction, we should pay more attention to admission National Institutes of Health Stroke Scale score, age, and stroke phase, especially in acute cerebral infarction patients.

Risk Factors for the Development of Pneumonia in Stroke Patients: A Systematic Review and Meta-Analysis

Pneumonia is one of the most prevalent medical complications post-stroke. It can have negative impacts on the prognosis of stroke patients. This study aimed to determine the predictors of pneumonia in stroke patients. The authors devised, reviewed, and enhanced the search strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were gathered from various electronic databases, including Medline, CINAHL, Cochrane, Embase, and Web of Science, from January 1st, 2011, to February 25th, 2024. The review encompassed studies involving patients aged 18 years and older who were hospitalized for acute stroke care. Inclusion criteria required patients to have received a clinical diagnosis of stroke, confirmed via medical imaging (CT or MRI), hospital primary diagnosis International Classification of Diseases 10th Revision discharge codes, or pathology reporting. A total of 35 studies met the criteria and were included in our pooled analysis. Among them, 23 adopted a retrospective design, while the remaining 12 were prospective. The pooled incidence of pneumonia among patients with stroke was found to be 14% (95% confidence interval = 13%-15%). The pooled analysis reported that advancing age, male gender, a history of chronic obstructive pulmonary disease (COPD), the presence of a nasogastric tube, atrial fibrillation, mechanical ventilation, stroke severity, dysphagia, and a history of diabetes were identified as significant risk factors for pneumonia development among stroke patients. Our results underscore the importance of proactive identification and management of these factors to mitigate the risk of pneumonia in stroke patients.

Prevalence of Stroke-Associated Pneumonia and Its Predictors Among Hyperglycaemia Patients During Acute Ischemic Stroke

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.

The Association between Statins Intake and Risk of Post Stroke Pneumonia: A Systematic Review and Meta-Analysis

AIM

This research aimed to examine the relationship between the intake of statins and the risk of post-stroke pneumonia in a systematic review and meta-analysis study.

METHODS

An extensive search of published articles on March 21st, 2023, was done in several databases, like Web of Science (ISI), PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. The Newcastle Ottawa Scale (NOS) checklist was employed to evaluate the quality of observational studies. Statistical tests (Chi-square test and I2) and graphical techniques (Forest plot) were used to determine whether heterogeneity existed in the meta-analysis studies. Funnel plots and Begg and Egger's tests were used to assess the publication bias.

RESULTS

Seven studies (5 cohort and 2 case-control studies) were retrieved to examine the association between statins and post-stroke pneumonia. The sample size of the studies compiled in the meta- analysis was obtained to be 68,966 participants. Meta-analysis demonstrated that the overall odds of post-stroke pneumonia in the statin group was equal to 0.87 (95% CI: 0.67 - 1.13; p-value 0.458). Subgroup analysis indicated that the odds of post-stroke pneumonia in the statin group was equal to 0.93 (95% CI: 0.73-1.18; p-value = 0.558) in the cohort studies, and equal to 0.92 (95% CI: 0.37-2.26; p-value = 0.857) in the case-control studies. The examination of the association between the intake of statins and post-stroke pneumonia showed no evidence of publication bias (Begg's test, p-value = 0.368; Eggers test, p-value = 0.282).

CONCLUSION

In this study, no relationship has been observed between receiving statins and the risk of post-stroke pneumonia.

Prevalence, associated factors and predictors of post stroke pneumonia in a Nigerian population: A retrospective study

OBJECTIVES

Stroke can trigger an immune response that can raise the risk of infection, alter tracheal epithelium, reduce pulmonary clearance and impair secretions drainage capacity. Infection, altered tracheal epithelium, reduced pulmonary clearance, impaired secretions drainage capacity and aspiration can cause pneumonia after stroke. The aim of this study is to find out the prevalence of post stroke pneumonia in a Nigerian population and factors that are associated with it.

MATERIALS AND METHOD

Study data was extracted from the case files of patients with stroke who were managed between 1st January, 2011 and 1st February, 2021 in the study setting.

RESULTS

The result showed that, there was a record of only 591 patients with stroke (mean age, 62.78 ± 14.86 years) who were managed in the two hospitals during the period of the study. Out of this number, only 102 (17.3 %) had pneumonia. Presence of the pneumonia was only significantly (p < 0.05) associated with sex, type of stroke, lower limb muscle power, and outcome (died or alive). However, only those with ischaemic stroke are less likely to have pneumonia (Odds ratio=  0.467; CI: 0.275 to 0.791, p=  0.005), and patients who survived the stroke and are alive are less likely to develop pneumonia (Odds ratio=  0.150; CI: 0.092 to 0.245, p < 0.001).

CONCLUSIONS

Pneumonia occurs to a large extent after stroke. Therefore, it is important measures are taken to prevent it or complications arising from it especially in those with a hemorrhagic stroke.

Influences of long-term care insurance on pulmonary and urinary tract infections among older people with disability

BACKGROUND

Pulmonary infection (PI) and urinary tract infection (UTI) have been the most common cause of hospitalization and most frequent infection respectively in older people with disability (OPWD). Long-term care insurance (LTCI) policy, intending to provide services to reduce the disease burden of OPWD, it remains unclear whether LTCI could reduce PI-, and UTI-related hospitalizations. This quasi-experimental study aimed to assess the influences of LTCI on all-cause, especially PI- and UTI-related hospitalizations among OPWD and the variation across sociodemographic characteristics.

METHODS

32,120 participants in the Chengdu Long-term Care Insurance cohort were considered the intervention group, and 2,704 not covered by the LTCI were in the control group. A total of 3,134,160 hospitalization records were collected between January 2014 and June 2021. A doubly robust difference-in-differences (DID) method was used to estimate the average treatment effect on the treated (ATT), indicating the average effect of LTCI on intervention group.

RESULTS

The average monthly all-cause, PI-, and UTI-related hospitalization rates were 16.3%, 4.0% and 0.5% in the intervention group, respectively, and were 19.3%, 3.9% and 0.5% in the control group, respectively. Under LTCI, all-cause (ATT [95% CI]: 7.15% [6.41%, 7.88%]), PI- (3.25% [2.76%, 3.74%]), and UTI-related hospitalizations (0.46% [0.28%, 0.64%]) were decreased. The influences of LTCI became significant after 5 months since the LTCI implementation and remained stable over time. The impact was more pronounced among those with longer coverage. The overall reduction was stronger in those who were not married, lived alone, and resided in institutions.

CONCLUSIONS

LTCI may reduce the occurrence of all-cause, PI-, and UTI-related hospitalizations in OPWD, with stronger influences observed over an extended period of implementation. The implementation of LTCI can play a role in reducing the burden of infectious diseases in OPWD and the care burden of families and society.

Association between triglyceride-glucose index and all-cause mortality in critically ill patients with ischemic stroke: analysis of the MIMIC-IV database

BACKGROUND

The triglyceride-glucose (TyG) index was significantly associated with insulin resistance (IR). Several studies have validated the effect of TyG index on cerebrovascular disease. However, the value of TyG index in patients with severe stroke requiring ICU admission remains unclear. The aim of this study was to investigate the association between the TyG index and clinical prognosis of critically ill patients with ischemic stroke (IS).

METHODS

This study identified patients with severe IS requiring ICU admission from the Medical Information Mart for Intensive Care (MIMIC-IV) database, and divided them into quartiles based on TyG index level. The outcomes included in-hospital mortality and ICU mortality. The association between the TyG index and clinical outcomes in critically ill patients with IS was elucidated using Cox proportional hazards regression analysis and restricted cubic splines.

RESULTS

A total of 733 patients (55.8% male) were enrolled. The hospital mortality and intensive care unit (ICU) mortality reached 19.0% and 14.9%, respectively. Multivariate Cox proportional hazards analysis showed that the elevated TyG index was significantly related to all-cause death. After confounders adjusting, patients with an elevated TyG index had a significant association with hospital mortality (adjusted hazard ratio, 1.371; 95% confidence interval, 1.053-1.784; P = 0.013) and ICU mortality (adjusted hazard ratio, 1.653; 95% confidence interval, 1.244-2.197; P = 0.001). Restricted cubic splines revealed that a progressively increasing risk of all-cause mortality was related to an elevated TyG index.

CONCLUSION

The TyG index has a significant association with hospital and ICU all-cause death in critically ill patients with IS. This finding demonstrates that the TyG index might be useful in identifying patients with IS at high risk of all-cause death.

Predictive effect of triglyceride-glucose index on clinical events in patients with acute ischemic stroke and type 2 diabetes mellitus

BACKGROUND

The triglyceride-glucose (TyG) index was significantly related to clinical outcome in patients with cardiovascular disease (CAD) and cerebrovascular disease (CVD). We aim to investigate the association between TyG index and clinical prognosis of acute ischemic stroke (IS) patients with type-2 diabetes mellitus (T2DM).

METHODS

Among 19,604 patients with acute IS admitted to the China National Stroke Registry II (CNSRII), 3359 IS patients with T2DM were included in the cross-sectional analysis. The TyG index (calculated by ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]) was split into four quartiles. The outcomes included recurrent IS, all-cause death and poor outcome at 1 year were analyzed. The association between the TyG index and adverse cerebrovascular outcomes was assessed by proportional hazards regression analysis.

RESULTS

During 1 year follow-up, recurrent IS, all-cause death and poor outcome occurred in 305 (9.08%), 229 (6.82%) and 443 (47.9%) cases, respectively. Multivariable Cox proportional hazards analyses showed that the risk of incident primary endpoints was associated with a higher TyG quartile. After adjustment for confounding factors, patients with a higher TyG index had an association with IS recurrence (adjusted hazard ratio, 1.41; 95% confidence interval, 0.97-2.03; P = 0.048) and all-cause death (adjusted hazard ratio, 1.70; 95% confidence interval, 1.062-2.74; P = 0.028), compared with those in the first quartile at 1 year time follow-up. In addition, there were interactions between TyG index and age (≥ 65), female, hypertensive agents, anticoagulant agents, statins and antidiabetic agents in subgroup analyses, especially patients without taken anticoagulant drugs were significantly related to IS recurrence, all-cause death and poor outcome (P = 0.003, P = 0.006 and P = 0.001, respectively).

CONCLUSIONS

TyG index is strongly related to the IS recurrence and all-cause death in acute IS patients with T2DM. This finding indicates that the TyG index might be a potential predictor of clinical outcome for acute IS patients with T2DM.

In-hospital mortality and its predictors among adult stroke patients admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

Introduction

Stroke is the second-leading global cause of death next to ischemic heart disease. The burden of stroke mortality, morbidity, and disability is increasing across the world. In Ethiopia, evidence on the survival status of adult stroke patients is insufficient. The purpose of this study is to estimate in-hospital mortality and its predictors among adult stroke patients.

Methods

Institution-based retrospective follow-up study was conducted on adult stroke patients who were admitted to Debre Markos Comprehensive Specialized Hospital from 1 November 2015 to 31 October 2020. Through simple random sampling, 382 patient charts were selected from 1125 stroke patients for 5 years follow-up period. Data were entered using EpiData™ version 4.1 and exported to Stata/SE™ version 14 for cleaning, coding, categorizing, and analysis. Predictor variables were selected using 95% confidence interval with a corresponding adjusted hazard ratio.

Results

In this study, 219 (57.33%) males and the mean (standard deviation) age of 57.65 ± 14.3 years. The in-hospital mortality rate of stroke was 12.8%; the median (interquartile range) time to mortality and Glasgow Coma Scale were 7 (4-13) days and 14 (11-15), respectively. The incidence of in-hospital mortality was 29/1000, 11/1000, 8/1000, and 13.6/1000 person-days in the first, second, third, and end of follow-up weeks, respectively. Pneumonia (adjusted hazard ratio = 3.51 (95% confidence interval = 1.86, 6.61)), hemorrhagic stroke (adjusted hazard ratio = 2.03 (95% confidence interval = 1.03, 3.99)), moderate impairment Glasgow Coma Scale (9-12) (adjusted hazard ratio = 2.16 (95% confidence interval = 1.08, 4.29)), severe impairment Glasgow Coma Scale (3-8) (adjusted hazard ratio = 2.38 (95% confidence interval = 1.01, 5.67)), history of hypertension (adjusted hazard ratio = 2.01 (95% confidence interval = 1.08, 3.74)), and increased intracranial pressure (adjusted hazard ratio = 2.12 (95% confidence interval = 1.10, 4.07)) were statistically significant predictors for in-hospital mortality.

Conclusion

In-hospital mortality of stroke was relatively high, and the median time to mortality was 8 days. Pneumonia, hemorrhagic stroke, Glasgow Coma Scale, history of hypertension, and increased intracranial pressure were identified predictors.

An exploratory descriptive cohort study of 90-day prognosis after acute ischaemic stroke with mechanical thrombectomy

AIM

To evaluate the relationship between nursing assessment findings at discharge and acute ischaemic stroke (AIS) patient prognosis after mechanical thrombectomy (MT).

METHODS

We analysed the characteristics of 144 AIS patients with MT treatment admitted to a university affiliated teaching hospital in Chengdu, Sichuan Province China, from January 2020 to December 2020. The modified Rankin Scale (mRS) score was used to assess outcomes 90-days after discharge. Exploratory analyses were undertaken using IBM SPSS Statistics (Version 26.0).

RESULTS

At 90-days, 47.9% (n = 69) had a good prognosis (mRS ≤ 2) including 22.2%(n = 32) fully recovered patients. There were 5 (3.5%) deceased patients and 48.6% (n =70) of patients had a poor prognosis (mRS ≥ 3). In univariate analysis, clinical prognosis correlated with the need for inpatient endotracheal intubation (p = 0.02), nasogastric tube (p＜0.001), indwelling urinary catheter (p＜0.001), central venous catheter (p = 0.03), health knowledge needs of pressure injury prevention (p = 0.03), National Institute of Health Stroke Scale (NIHSS) score (p＜0.001) and Activities of Daily Living (ADL) score (p＜0.001) at the time of discharge from hospital. The average hospitalisation time of the 144 patients was 12[IQR, 9-25] days, and the average cost of hospitalisation was $Y$21291.93 (SD 9165.01).

CONCLUSION

Almost half of the surviving patients had a poor prognosis. In our country, this surgery and rehabilitation impose a significant financial burden that needs to be addressed. However, the longer length of hospital stay and higher costs at discharge may be contributing factors to worse outcomes. The outcomes of comprehensive nursing assessment of the patients, including nursing needs, activities of daily living, and neurological function, can predict their outcome.

IMPACT STATEMENT

We recommend a comprehensive nursing assessment at discharge that predicts patient outcomes and can be used for subsequent targeted interventions. The prognosis of patients with acute ischaemic stroke after mechanical thrombectomy is poor, and the financial burden needs to be considered.

Factors associated with stroke associated pneumonia among adult stroke patients admitted to university of Gondar hospital, Northwest Ethiopia

Stroke is the major cause of disability and death in sub-Saharan African countries. The presence and severity of complications play a major role in the outcome of stroke. Stroke associated pneumonia is often noticed post stroke infection that has been linked to an increased risk of hospital mortality, a longer hospital stay and higher healthcare expenses. Report on details of stroke-associated pneumonia has never been documented in countries of sub-Saharan Africa. This study aimed to determine the incidence and risk factors of stroke-associated pneumonia among adult stroke patients in hospital settings, Northwest Ethiopia. The study was undertaken at a stroke care unit, University of Gondar hospital between January 1, 2020 and December 31, 2020. A convenience sampling method was used to recruit study subjects. Relevant clinical history was taken, focused physical examination was done, and brain imaging (CT scan or MRI) was performed to settle the diagnosis of stroke. A modified Centre for Disease Control and Prevention (CDC) criteria was used to diagnose stroke-associated pneumonia. All patients with stroke-associated pneumonia were treated according to the 2016 Infectious Diseases Society of America/American Thoracic Society Clinical Practice Guidelines. The Data were cleaned in Epi Info version 4.6.0.2, and analyzed using SPSS version 26. Variables associated with stroke-associated pneumonia were computed using logistic regression analysis. P value < 0.05 was considered to declare statistical significance. The study comprised a total of 325 adult stroke patients. The mean age of study subjects was 65.2 years (SD ± 15.7). The most prevalent type of stroke was ischemic stroke, which accounted for 68% of all cases. Hemiparesis (94%), facial palsy (87%), and swallowing disturbance (51%) were the frequently noticed neurological findings. Stroke-associated pneumonia complicated 116/325 (36%) of stroke patients. Multi-variate regression analysis revealed that patients who were elderly (age > 75 years) (AOR = 3.910, CI 1.181-12.936, P = 0.026), had swallowing disturbance (AOR = 4.656, CI 2.356-9.202, P-value < 0.001), epileptic seizures (AOR = 2.678, 95% CI 1.253-5.721, P-value < 0.001) and moderate to severe stroke (NIHSS score = 16-21) (AOR = 5.994, 95% CI 2.043-17.585, P-value < 0.001) were at risk of developing stroke-associated pneumonia. SAP was a substantial medical complication among stroke patients. Early identification and prompt intervention measures for the identified risk factors might address the burden of SAP.