Department of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Department of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Am J Emerg Med. 2021 Mar;41:55-59. doi: 10.1016/j.ajem.2020.12.036. Epub 2020 Dec 23.
This study aimed to analyze the risk factors for stroke-associated pneumonia (SAP) and assess the predictive effect of neutrophil-to-lymphocyte ratio (NLR) on acute SAP.
The study included acute stroke patients from April 2018 to June 2019. These patients were divided into the SAP and Non-SAP groups. The patients' history of chronic diseases was assessed, including history of hypertension, diabetes, hyperlipidemia, chronic lung disease, and current smoking status. The clinical characteristics of all studied cases were recorded, including the initial stroke type (cerebral infarction or cerebral hemorrhage), National Institute of Health Stroke Scale (NIHSS) score, indwelling nasogastric tubes, stroke-associated pneumonia within 7 days of hospitalization, and length of hospitalization. The study also recorded the laboratory testing data, including fasting blood glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol, glycosylated hemoglobin, and high-sensitivity C-reactive protein (hsCRP) as well as white blood cell (WBC), neutrophil, and lymphocyte counts. SPSS 19.0 was used for statistical analysis.
A total of 328 eligible acute stroke patients were included. Among all participants, SAP occurred in 64 (19.5%) patients. In the SAP group, the patients were older, the proportion of cerebral hemorrhage was higher, the NIHSS score was higher, and more patients had nasogastric tubes (P < 0.05). Concomitantly, the blood glucose, hsCRP, WBC count, neutrophil count, and NLR of the SAP group were significantly higher than those of the Non-SAP group, whereas the lymphocyte count was significantly lower than that of the Non-SAP group (P < 0.05). Multivariable analysis of Binary Logistic regression revealed that stroke type (cerebral hemorrhage), indwelling gastric tube, and NLR were independent risk factors for SAP. Receiver operating characteristic curve analysis demonstrated that the area under the curve for the NLR's ability to predict SAP was 0.861. The optimal cutoff threshold, sensitivity, and specificity were 3.745, 0.891, and 0.727, respectively.
The risk factors for SAP were multifaceted. Cerebral hemorrhage, indwelling nasogastric tube, and high NLR were independent risk factors. An early NLR had a predictive effect on the occurrence of SAP in patients with acute stroke.
本研究旨在分析卒中相关性肺炎（SAP）的危险因素，并评估中性粒细胞与淋巴细胞比值（NLR）对急性 SAP 的预测作用。
本研究纳入了 2018 年 4 月至 2019 年 6 月期间的急性脑卒中患者。这些患者被分为 SAP 组和非 SAP 组。评估了患者的慢性病史，包括高血压、糖尿病、高脂血症、慢性肺病和当前吸烟状况。记录了所有研究病例的临床特征，包括初始卒中类型（脑梗死或脑出血）、国立卫生研究院卒中量表（NIHSS）评分、留置鼻胃管、住院 7 天内发生的卒中相关性肺炎以及住院时间。还记录了实验室检查数据，包括空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白和高敏 C 反应蛋白（hsCRP）以及白细胞（WBC）、中性粒细胞和淋巴细胞计数。使用 SPSS 19.0 进行统计分析。
共纳入了 328 例符合条件的急性脑卒中患者。在所有参与者中，SAP 发生在 64 例（19.5%）患者中。在 SAP 组中，患者年龄较大，脑出血比例较高，NIHSS 评分较高，且有更多的患者留置胃管（P<0.05）。同时，SAP 组的血糖、hsCRP、WBC 计数、中性粒细胞计数和 NLR 明显高于非 SAP 组，而淋巴细胞计数明显低于非 SAP 组（P<0.05）。二元 Logistic 回归多变量分析显示，卒中类型（脑出血）、留置胃管和 NLR 是 SAP 的独立危险因素。受试者工作特征曲线分析表明，NLR 预测 SAP 的曲线下面积为 0.861。最佳截断值、敏感性和特异性分别为 3.745、0.891 和 0.727。
SAP 的危险因素是多方面的。脑出血、留置胃管和高 NLR 是独立的危险因素。早期 NLR 对急性脑卒中患者 SAP 的发生具有预测作用。
