Department of Neurology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China.
Brain Behav. 2022 Jul;12(7):e2675. doi: 10.1002/brb3.2675. Epub 2022 Jun 24.
We aimed to explore the association between the baseline hypersensitive C-reactive protein-albumin ratio (CAR) and stroke-associated pneumonia (SAP) during hospitalization and the short-term prognosis in patients with acute ischemic stroke (AIS).
We enrolled 766 patients with AIS and collected their admission baseline characteristics, including their National Institutes of Health Stroke Scale score, CAR, age, atrial fibrillation, dysphagia, sex, stroke severity (A DS ) score, and other information. The occurrence of SAP within 7 days after stroke, length of hospital stay, and physical condition at discharge were also recorded. The patients' Modified Rankin Scale (mRS) scores and mortality 3 months after AIS were further evaluated at follow-up. All patients were divided into four groups based on the quartiles of the admission CAR (Q1 <1.3, Q2 1.3-3.7, Q3 3.7-9.3, Q4 ≥9.3).
During hospitalization, 92 (11.9%) patients were diagnosed with SAP. The patients with SAP had a higher CAR than the non-SAP patients (p < .001). In the multivariate-adjusted model, the patients in the Q3 and Q4 groups had a higher SAP risk (aOR was 5.21 and 17.72, p-trend < .001) than those in the lowest quartile. The area under the curve for the CAR's ability to predict SAP was 0.810 in the receiver operating characteristic curve analysis and had a similar predictive efficacy as the A DS score (p <.05). The length of stay in the SAP group was almost the same as that in the non-SAP group, but the clinical outcomes were worse at discharge and at the 3-month follow-up in the SAP group. In addition, the patients in the higher CAR quartiles at admission were more likely to have poorer clinical outcomes.
Patients with AIS with a high CAR at admission are more likely to develop SAP during hospitalization and have poor short-term clinical outcomes. These findings might help to timely identify patients at high risk of SAP and provide a basis for further research on prophylactic antibiotic therapy.
本研究旨在探讨急性缺血性脑卒中（AIS）患者入院时基线超敏 C 反应蛋白-白蛋白比值（CAR）与住院期间卒中相关性肺炎（SAP）的关系及其对短期预后的影响。
本研究纳入了 766 例 AIS 患者，收集了患者入院时的基本特征，包括美国国立卫生研究院卒中量表（NIHSS）评分、CAR、年龄、房颤、吞咽困难、性别、卒中严重程度评分（A DS 评分）等信息。还记录了患者卒中后 7 天内 SAP 的发生情况、住院时间以及出院时的身体状况。在随访时，进一步评估了患者 3 个月时的改良 Rankin 量表（mRS）评分和死亡率。根据入院时 CAR 的四分位数（Q1<1.3、Q2 1.3-3.7、Q3 3.7-9.3、Q4≥9.3），将所有患者分为四组。
住院期间，92 例（11.9%）患者被诊断为 SAP。SAP 患者的 CAR 明显高于非 SAP 患者（p<0.001）。在多因素调整模型中，Q3 和 Q4 组患者发生 SAP 的风险更高（优势比分别为 5.21 和 17.72，p 趋势<0.001）。CAR 预测 SAP 的受试者工作特征曲线下面积为 0.810，与 A DS 评分的预测效果相当（p<0.05）。SAP 组的住院时间与非 SAP 组相似，但 SAP 组出院时和 3 个月随访时的临床结局更差。此外，入院时 CAR 较高的患者更有可能出现不良的临床结局。
入院时 CAR 较高的 AIS 患者在住院期间更易发生 SAP，且短期临床结局较差。这些发现可能有助于及时识别 SAP 高危患者，并为进一步研究预防性抗生素治疗提供依据。
