Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
Postgrad Med. 2023 Sep;135(7):681-689. doi: 10.1080/00325481.2023.2261354. Epub 2023 Oct 24.
Early recognition of stroke-associated pneumonia (SAP) is critical to reducing morbidity and mortality associated with SAP. This study investigated the predictors of SAP, and the predictive value of the neutrophil percentage-to-albumin ratio (NPAR) for SAP.
This retrospective cohort study was conducted among stroke patients admitted to Jordan University Hospital from January 2015 to May 2021. Multivariable logistic regression was used to identify independent predictors for SAP. The predictive performance was assessed using C-statistics, described as the area under the receiver-operating characteristic curve (AUC, ROC) with a 95% confidence interval.
Four hundred and six patients were included in the analysis, and the prevalence of SAP was 19.7%. Multivariable logistic analysis showed that males (Adjusted Odds Ratio (AOR): 5.74; 95% Confidence Interval (95%CI): 2.04-1 6.1)], dysphagia (AOR: 5.29; 95% CI: 1.80-15.5), hemiparesis (AOR: 3.27; 95% CI: 1.13-9.47), lower GCS score (AOR: 0.73; 95% CI: 0.58-0.91), higher levels of neutrophil-lymphocyte ratio (NLR) (AOR: 1.15; 95% CI: 1.07-1.24), monocyte-lymphocyte ratio (MLR) (AOR: 1.49; 95% CI: 1.13-1.96), and neutrophil percentage to albumin ratio (NPAR) (AOR: 1.53; 95% CI: 1.33-1.76) were independent predictors of SAP. The NPAR demonstrated a significantly higher AUC than both the NLR (0.939 versus 0.865, Z = 3.169, = 0.002) and MLR (0.939 versus 0.842, Z = 3.940, < 0.001). The AUCs of the NLR and MLR were comparable (0.865 versus 0.842, Z = 1.274, = 0.203).
Male gender, dysphagia and hemiparesis were the strongest predictors of SAP, and NPAR has an excellent performance in predicting SAP which was better than high NLR and MLR.
早期识别卒中相关性肺炎（SAP）对于降低 SAP 相关发病率和死亡率至关重要。本研究旨在探讨 SAP 的预测因素，以及中性粒细胞百分比与白蛋白比值（NPAR）对 SAP 的预测价值。
本回顾性队列研究纳入了 2015 年 1 月至 2021 年 5 月期间在约旦大学医院住院的卒中患者。采用多变量逻辑回归分析确定 SAP 的独立预测因素。采用 C 统计量评估预测性能，描述为接收者操作特征曲线下的面积（AUC，ROC），并附有 95%置信区间。
共纳入 406 例患者，SAP 的患病率为 19.7%。多变量逻辑分析显示，男性（校正优势比（AOR）：5.74；95%置信区间（95%CI）：2.04-16.1]）、吞咽困难（AOR：5.29；95%CI：1.80-15.5）、偏瘫（AOR：3.27；95%CI：1.13-9.47）、格拉斯哥昏迷评分较低（AOR：0.73；95%CI：0.58-0.91）、中性粒细胞与淋巴细胞比值（NLR）较高（AOR：1.15；95%CI：1.07-1.24）、单核细胞与淋巴细胞比值（MLR）较高（AOR：1.49；95%CI：1.13-1.96）和中性粒细胞与白蛋白比值（NPAR）较高（AOR：1.53；95%CI：1.33-1.76）是 SAP 的独立预测因素。NPAR 与 NLR（0.939 对 0.865，Z=3.169， =0.002）和 MLR（0.939 对 0.842，Z=3.940， <0.001）相比，具有更高的 AUC。NLR 和 MLR 的 AUC 相当（0.865 对 0.842，Z=1.274， =0.203）。
男性、吞咽困难和偏瘫是 SAP 的最强预测因素，NPAR 在预测 SAP 方面表现出色，优于 NLR 和 MLR。
