Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore.
Ann Acad Med Singap. 2017 Jun;46(6):237-244.
Although pneumonia is a major complication after acute ischaemic stroke (AIS), pneumonia prediction scores have not been extensively validated. This study aimed to compare the discrimination performance of 5 pneumonia prediction scores in AIS patients.
We retrospectively reviewed all consecutive adult AIS patients whom presented to our emergency department within 4.5 hours of symptom-onset between January 2012 and February 2015. Diagnosis had to be made by a neurologist and infarcts confirmed by neuroimaging. We excluded patients with pneumonia on presentation. Pneumonia predictors were based on the 5 prediction scoring models: Kwon's score, Chumbler's score, Acute Ischaemic Stroke-Associated Pneumonia Score (AIS-APS), ADS score and ISAN score. The definition of stroke-associated pneumonia was based on the criteria by the Pneumonia in Stroke Consensus Group. Analysis using area under receiver operating characteristics curve (AUROC) was performed.
Forty (5.5%) out of 731 patients analysed had stroke-associated pneumonia (SAP). ADS score had the highest discrimination capacity (AUROC 0.88; 95% CI, 0.84 to 0.92), followed by AIS-APS (AUROC 0.87; 95% CI, 0.83 to 0.91), Kwon's score (AUROC 0.86; 95% CI, 0.82 to 0.92), Prestroke Independence, Sex, Age and National Institutes of Health Stroke Scale (ISAN) score (AUROC 0.85; 95% CI, 0.80 to 0.90) and Chumbler's score (AUROC 0.79; 95% CI, 0.74 to 0.84). However, there was no statistical difference of discrimination capacity among ADS score, AIS-APS and Kwon's score.
ADS , AIS-APS and Kwon's scores performed comparably in discriminating SAP in AIS patients.
尽管肺炎是急性缺血性脑卒中（AIS）后的主要并发症，但肺炎预测评分并未得到广泛验证。本研究旨在比较 5 种肺炎预测评分在 AIS 患者中的鉴别性能。
我们回顾性分析了 2012 年 1 月至 2015 年 2 月期间在症状发作后 4.5 小时内到我院急诊就诊的所有连续成年 AIS 患者。诊断必须由神经科医生做出，梗塞通过神经影像学证实。我们排除了入院时患有肺炎的患者。肺炎预测因素基于 5 种预测评分模型：Kwon 评分、Chumbler 评分、急性缺血性脑卒中相关性肺炎评分（AIS-APS）、ADS 评分和 ISAN 评分。脑卒中相关性肺炎的定义基于脑卒中肺炎共识组的标准。使用受试者工作特征曲线下面积（AUROC）进行分析。
在分析的 731 例患者中，有 40 例（5.5%）患有脑卒中相关性肺炎（SAP）。ADS 评分具有最高的鉴别能力（AUROC 0.88；95%CI，0.84 至 0.92），其次是 AIS-APS（AUROC 0.87；95%CI，0.83 至 0.91）、Kwon 评分（AUROC 0.86；95%CI，0.82 至 0.92）、Prestroke 独立性、性别、年龄和国立卫生研究院脑卒中量表（ISAN）评分（AUROC 0.85；95%CI，0.80 至 0.90）和 Chumbler 评分（AUROC 0.79；95%CI，0.74 至 0.84）。然而，ADS 评分、AIS-APS 和 Kwon 评分之间的鉴别能力没有统计学差异。
在 AIS 患者中，ADS、AIS-APS 和 Kwon 评分在鉴别 SAP 方面表现相当。
