Centre for Stroke Research Berlin, Charite-Universitätsmedizin, Berlin, Germany.
Stroke. 2012 Oct;43(10):2617-23. doi: 10.1161/STROKEAHA.112.653055. Epub 2012 Jul 12.
Poststroke pneumonia is a potentially preventable complication after stroke associated with poor outcome. We developed and externally validated a prognostic score for predicting risk of pneumonia after ischemic stroke.
The prognostic score was developed based on clinical data routinely collected after admission from the Berlin Stroke Register, Germany. The association of demographics, comorbidities, and clinical characteristics with poststroke pneumonia was investigated using multivariable logistic regression analyses. Independent predictors of poststroke pneumonia were translated into a point scoring system based on the corresponding regression coefficients. The predictive properties of the developed prognostic score were externally validated using an independent data set from the Stroke Register Northwest-Germany.
Between 2007 and 2009, 15 335 patients with ischemic stroke were registered within the Berlin Stroke Register. The observed rate of pneumonia in hospital was 7.2%. A 10-point score was derived for prediction of poststroke pneumonia (Age ≥ 75 years=1, Atrial fibrillation=1, Dysphagia=2, male Sex=1, stroke Severity, National Institutes of Health Stroke Scale 0-4=0, 5-15=3, ≥ 16=5; A(2)DS(2)). The proportion of pneumonia varied between 0.3% in patients with a score of 0 point to 39.4% in patients with a score of 10 points. The score demonstrated excellent discrimination (C-statistic 0.84; 95% CI, 0.83-0.85) and calibration (McFadden R(2)=0.21). Prediction, discrimination, and calibration properties were reproduced in the validation cohort consisting of 45 085 patients with ischemic stroke.
The A(2)DS(2) score is a valid tool for predicting poststroke pneumonia based on routinely available data. A(2)DS(2) might be useful for guiding monitoring of high-risk patients or prophylactic pneumonia management in clinical routine.
脑卒中后肺炎是一种潜在可预防的脑卒中并发症，与不良预后相关。我们开发并验证了一种用于预测缺血性脑卒中后肺炎风险的预后评分。
该预后评分基于德国柏林脑卒中登记处入院后常规收集的临床数据建立。采用多变量逻辑回归分析探讨人口统计学特征、合并症和临床特征与脑卒中后肺炎的关系。将脑卒中后肺炎的独立预测因素转化为基于相应回归系数的评分系统。使用来自德国西北部脑卒中登记处的独立数据集对所开发的预后评分进行外部验证。
2007 年至 2009 年期间，德国柏林脑卒中登记处共登记了 15335 例缺血性脑卒中患者。住院期间肺炎的发生率为 7.2%。为预测脑卒中后肺炎，我们制定了一个 10 分的评分（年龄≥75 岁=1 分、心房颤动=1 分、吞咽困难=2 分、男性=1 分、脑卒中严重程度、美国国立卫生研究院脑卒中量表 0-4=0 分、5-15=3 分、≥16=5 分；A2DS2）。评分 0 分的患者中肺炎发生率为 0.3%，评分 10 分的患者中肺炎发生率为 39.4%。该评分具有良好的区分度（C 统计量 0.84；95%CI，0.83-0.85）和校准度（McFadden R2=0.21）。该评分在包含 45085 例缺血性脑卒中患者的验证队列中得到了重现。
A2DS2 评分是一种基于常规数据预测脑卒中后肺炎的有效工具。A2DS2 可能有助于指导高危患者的监测或临床常规中的预防性肺炎管理。
