Lobo Chaves Marco Antonio, Gittins Matthew, Bray Benjamin, Vail Andy, Smith Craig J
Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK.
Geoffrey Jefferson Brain Research Centre, Northern Care Alliance NHS Group, Manchester, UK.
Cerebrovasc Dis. 2023;52(1):21-27. doi: 10.1159/000524917. Epub 2022 Jun 1.
It is not known whether modern stroke unit care reduces the impact of stroke complications, such as stroke-associated pneumonia (SAP), on clinical outcomes. We investigated the relationship between SAP and clinical outcomes, adjusting for the confounding effects of stroke care processes and their timing.
The Sentinel Stroke National Audit Programme provided patient data for all confirmed strokes between April 2013 and December 2018. SAP was defined as new antibiotic initiation for suspected pneumonia within the first 7 days from stroke admission. We compared outcomes after SAP versus non-SAP in appropriate multilevel mixed models. Each model was adjusted for patient and clinical characteristics, as well as markers of stroke care and their timing within the first 72 h. The appropriate effect estimates and corresponding 95% confidence intervals (CIs) were reported.
Of 201,778 patients, SAP was present in 14.2%. After adjustment for timing of acute stroke care processes and clinical characteristics, adverse outcomes remained for SAP versus non-SAP patients. In these adjusted analyses, patients with SAP maintained an increased risk of longer length of in-hospital stay (IRR of 1.27; 95% CI: 1.25, 1.30), increased odds of worse functional outcome at discharge (OR of 2.9; 95% CI: 2.9, 3.0), and increased risk of in-hospital mortality (HR of 1.78; 95% CI: 1.74, 1.82).
We show for the first time that SAP remains associated with worse clinical outcomes, even after adjusting for processes of acute stroke care and their timing. These findings highlight the importance of continued research efforts aimed at preventing SAP.
目前尚不清楚现代卒中单元护理是否能减轻卒中并发症（如卒中相关性肺炎，SAP）对临床结局的影响。我们研究了SAP与临床结局之间的关系，并对卒中护理过程及其时间安排的混杂效应进行了校正。
哨兵卒中全国审计计划提供了2013年4月至2018年12月期间所有确诊卒中患者的数据。SAP定义为卒中入院后7天内因疑似肺炎开始使用新抗生素。我们在适当的多水平混合模型中比较了发生SAP与未发生SAP后的结局。每个模型都对患者和临床特征以及卒中护理指标及其在最初72小时内的时间安排进行了校正。报告了适当的效应估计值和相应的95%置信区间（CI）。
在201,778例患者中，14.2%存在SAP。在校正急性卒中护理过程的时间安排和临床特征后，SAP患者与未发生SAP的患者相比，不良结局仍然存在。在这些校正分析中，发生SAP的患者住院时间延长的风险增加（风险比为1.27；95%CI：1.25，1.30），出院时功能结局较差的几率增加（比值比为2.9；95%CI：2.9，3.0），住院死亡率增加（风险比为1.78；95%CI：1.74，1.82）。
我们首次表明，即使在校正急性卒中护理过程及其时间安排后，SAP仍与较差的临床结局相关。这些发现凸显了持续开展旨在预防SAP的研究工作的重要性。
