Kishore Amit, Kishore Amit K, Heal Calvin, Onochie-Williams Anna, Jamil Husam, Smith Craig J
Greater Manchester Comprehensive Stroke Centre, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance, Salford Royal, Salford, UK.
Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Cerebrovasc Dis. 2025;54(5):639-645. doi: 10.1159/000540218. Epub 2024 Oct 16.
Stroke-associated pneumonia (SAP) frequently complicates stroke and is associated with significant mortality. Clinicians often use physiological variables within the National Early Warning Score (NEWS) when diagnosing and prescribing antibiotics for SAP, but little is known of its association with mortality. We investigated the relationship of the NEWS 2 score and its components (respiratory rate, heart rate, temperature, oxygen requirement, oxygen saturation, and alertness level) prior to antibiotic initiation, with time-to-mortality in SAP.
We included patients with SAP (n = 389) from a single hyperacute stroke unit. Diagnosis of SAP was made if pneumonia occurred within 7 days of hospital admission. Kaplan-Meier survival curves were generated to assess NEWS 2 parameters influencing survival at pre-defined time periods (1 year and 5 years). The association of these parameters on time-to-mortality were analysed using multivariable Cox-regression models to account for a set of pre-specified potential confounders.
The median age was 80 years (71-87 years) and median NIHSS was 7 (IQR 4-17). Mortality within 1 year was 52.4% and 65.8% within 5 years. In the multivariable analyses, time-to-mortality was independently associated with respiratory rate (heart rate [HR] 1.04, 95% confidence intervals [CI] 1.01-1.08, p = 0.009) and total NEWS 2 score (HR 1.13, 95% CI 1.06-1.21, p < 0.001).
In patients with SAP, higher respiratory rate and total NEWS 2 score prior to antibiotic initiation were independently associated with time-to-mortality. Further studies are warranted to identify potential opportunities for intervention and ultimately guide treatment to improve outcomes in SAP patients.
卒中相关性肺炎（SAP）常使卒中病情复杂化，并与显著的死亡率相关。临床医生在诊断SAP并开具抗生素处方时，经常使用国家早期预警评分（NEWS）中的生理变量，但对其与死亡率的关联了解甚少。我们研究了抗生素开始使用前NEWS 2评分及其组成部分（呼吸频率、心率、体温、氧需求、血氧饱和度和意识水平）与SAP患者死亡时间的关系。
我们纳入了来自单个超急性卒中单元的SAP患者（n = 389）。如果肺炎在入院后7天内发生，则诊断为SAP。绘制Kaplan-Meier生存曲线，以评估在预定义时间段（1年和5年）影响生存的NEWS 2参数。使用多变量Cox回归模型分析这些参数与死亡时间的关联，以考虑一组预先指定的潜在混杂因素。
中位年龄为80岁（71 - 87岁），中位美国国立卫生研究院卒中量表（NIHSS）评分为7分（四分位间距4 - 17）。1年内死亡率为52.4%，5年内为65.8%。在多变量分析中，死亡时间与呼吸频率（心率[HR] 1.04，95%置信区间[CI] 1.01 - 1.08，p = 0.009）和总NEWS 2评分（HR 1.13，95% CI 1.06 - 1.21，p < 0.001）独立相关。
在SAP患者中，抗生素开始使用前较高的呼吸频率和总NEWS 2评分与死亡时间独立相关。有必要进行进一步研究，以确定潜在的干预机会，并最终指导治疗，以改善SAP患者的预后。
