Barlas Raphae S, Clark Allan B, Bettencourt-Silva Joao H, Sawanyawisuth Kittisak, Kongbunkiat Kannikar, Kasemsap Narongrit, Tiamkao Somsak, Myint Phyo Kyaw
Ageing Clinical and Experimental Research (ACER), Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresthill, Aberdeen, United Kingdom.
Stroke Research Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1448-1454. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.024. Epub 2019 Apr 4.
The impact of stroke associated pneumonia (SAP) on stroke complications is not well understood; we aimed to study the association between SAP and adverse outcomes including in-hospital mortality, prolonged length of stay and the risk of developing common serious complications (sepsis, respiratory failure, and convulsions).
We retrospectively analyzed data from a cohort of 610,668 stroke patients drawn from the Universal Coverage Health Security Scheme (a national insurance database) in Thailand which covers ∼80% of the Thai population. Patients were hospitalized between October 2004 and January 2013.
Pneumonia was present in 9.6 % (n = 58,586) of patients. Aspiration pneumonia was present in 6.2% (n = 38,060) and nonaspiration pneumonia in 3.4% (n = 20,526). After adjusting for age, sex, stroke type, and comorbidities, patients with SAP had significantly higher odds of in-hospital mortality (odds ratio [OR] 2.90: 2.83-2.96), long length of stay (OR 13.11: 12.83-13.40), sepsis (OR 8.49: 8.22-8.76), respiratory failure (OR 4.37: 4.27-4.48), and convulsions (OR 2.09: 2.00-2.17). On subanalysis, patients with nonaspiration pneumonia were found to have higher odds of adverse outcomes compared to aspiration pneumonia; the corresponding ORs (95% confidence interval) for above outcomes were 1.25 (1.21-1.30), 2.40 (2.32-2.49), 1.34 (1.28-1.40), 1.80 (1.73-1.88), and 1.19 (1.11-1.28), respectively.
SAP is associated with higher odds of inpatient mortality, long length of stay, and risk of developing serious stroke complications. Nonaspiration pneumonia is associated with significantly higher likelihood of adverse outcomes compared to aspiration pneumonia in this patient population. Early identification and treatment of SAP is vital in reducing adverse outcomes in acute stroke.
卒中相关性肺炎（SAP）对卒中并发症的影响尚未完全明确；我们旨在研究SAP与不良结局之间的关联，这些不良结局包括住院死亡率、住院时间延长以及发生常见严重并发症（脓毒症、呼吸衰竭和惊厥）的风险。
我们回顾性分析了来自泰国全民健康保险计划（一个覆盖约80%泰国人口的国家保险数据库）中610,668例卒中患者队列的数据。患者于2004年10月至2013年1月期间住院。
9.6%（n = 58,586）的患者存在肺炎。其中吸入性肺炎患者占6.2%（n = 38,060），非吸入性肺炎患者占3.4%（n = 20,526）。在调整年龄、性别、卒中类型和合并症后，SAP患者的住院死亡率（比值比[OR] 2.90：2.83 - 2.96）、住院时间延长（OR 13.11：12.83 - 13.40）、脓毒症（OR 8.49：8.22 - 8.76）、呼吸衰竭（OR 4.37：4.27 - 4.48）和惊厥（OR 2.09：2.00 - 2.17）的几率显著更高。亚组分析发现，与吸入性肺炎患者相比，非吸入性肺炎患者出现不良结局的几率更高；上述结局对应的OR（95%置信区间）分别为1.25（1.21 - 1.30）、2.40（2.32 - 2.49）、1.34（1.28 - 1.40）、1.80（1.73 - 1.88）和1.19（1.11 - 1.28）。
SAP与住院死亡率升高、住院时间延长以及发生严重卒中并发症的风险相关。在该患者群体中，与吸入性肺炎相比，非吸入性肺炎出现不良结局的可能性显著更高。早期识别和治疗SAP对于降低急性卒中的不良结局至关重要。
