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DOI:10.3969/j.issn.1009-6574.2021.02.009
Analysis of risk factors of acute ischemic stroke-associated pneumonia and construction of its predictivescoring model
Yang Dongdong, Zhang Zunsheng
()
Abstract:
Objective To explore the risk factors of acute ischemic stroke-associated pneumonia (SAP) and try to construct its predictive scoring model. Methods A total of 212 patients with acute ischemic strokeadmitted to the Neurology Department of the Affiliated Hospital of Xuzhou Medical University from January 2020 to May 2020 were retrospectively enrolled( all patients were admitted within 24 hours after onset), including 36 cases of SAP and 176 cases of non-SAP. The incidence rate of SAP was 17.0%. The clinical data were collected through the hospital medical record system. Univariate analysis was carried out firstly, and then multivariate logistic regression analysis was used to obtain the independent risk factors. According to their respective regression coefficients, scoring model was established for patients with acute ischemic stroke to predict the occurrence of SAP( a new SAP scoring model). By using the established new SAP scoring model, all the patients were scored, and the patients with acute ischemic stroke complicated with SAP were treated as the endpoint. The receiver operator characteristic( ROC) curve was drawn by SPSS software to evaluate the sensitivity and specificity of this predictive scoring model. Results (1) Univariate analysis results showedthatthere were statistically significant differences between SAP group and non-SAP groups in age, OCSP classification, prestroke mRS score, GCS score, NIHSS score, atrial fibrillation, heart failure, dysphagia, albumin, fasting blood glucose, leukocyte count, neutrophil count, lymphocyte count, and NLR( all P<0.05).( 2)Multivariate Logistic regression analysis results showed that NIHSS score≥16( OR=18.380, 95%CI:1.066-317.057), heart failure(OR=24.371, 95%CI:2.358-251.878),dysphagia(OR=54.383,95%CI:6.503-454.760), and NLR > 6.82(OR=310.779, 95%CI:37.176-2 598.024)werethe risk factors of SAP for patients with acute ischemic stroke( all P<0.05)(. 3) The new SAP scoring model included four items: NIHSS score( ≥16 scores 1;<16 scores 0), heart failure( yes=1; no=0), dysphagia( yes=1.5; no=0) and NLR( >6.82 scores 2; ≤ 6.82 scores 0). The area under the plotted ROC curve( AUC) was 0.966( 95%CI: 0.921-1.000, P< 0.05). The diagnostic boundary value corresponding to the curve was 1.25 points, corresponding sensitivity was 91.7% and specificity was 99.6%. Conclusions NIHSS score ≥ 16, heart failure, dysphagia, and NLR > 6.82 were independent risk factors of SAP for patients with acute ischemic stroke( within 24 hours of onset). The established new SAP scoring model for patients with acute ischemic stroke( within 24 hours of onset) has high accuracy in predicting their SAP occurrence. When the score ≥ 1.25 points, SAP may be alert to occur.
Key words:  Acute ischemic stroke  Stroke-associated pneumonia  Neutrophil count/lymphocyte count ratio  Predective scoring model

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