Wang Linlin, Xu Jun, Liu Xinyu, Ma Feifei, Zhao Xingquan, Wang Anxin, Ji Ruijun, Wang Yongjun
Department of Neurology, Tiantan Hospital Capital Medical University Beijing China.
China National Clinical Research Center for Neurological Diseases Beijing China.
Aging Med (Milton). 2025 Mar 20;8(2):137-144. doi: 10.1002/agm2.70003. eCollection 2025 Apr.
To compare the discrimination and calibration of six risk scoring systems in the assessment of patients with stroke-associated pneumonia (SAP) after acute ischemic stroke.
The validation cohort was derived from the Third China National Stroke Registry. SAP was diagnosed according to the criteria for hospital-acquired pneumonia of the Centers for Disease Control and Prevention. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess discrimination and calibration.
A total of 12,071 patients were included in the study and 606 (5.02%) patients were diagnosed with in-hospital SAP after ischemic stroke. The AUROC of the six clinical scores ranged from 0.660 to 0.752. In the pairwise comparison, the AIS-APS score (0.752, 95% CI = 0.730-0.773, < 0.001) showed significantly better discrimination than the other risk models, except the PASS score. The AIS-APS score had the largest Cox and Snell for in-hospital SAP after ischemic stroke. In the subgroup analysis, among patients over 61 years of age, all TOAST subtypes except small vessel disease, length of hospital stay longer than 8 days, male and female sex, different groups stratified by admission NIHSS score and time from onset to arrival, the AIS-APS score showed better discrimination than other risk models with regard to SAP after AIS.
Our study compared the discrimination and calibration of the Kwon Pneumonia Score, A2DS2 score, PANTHERIS score, AIS-APS score, ISAN score, and PASS score in SAP identification; of these, the AIS-APS score showed the best performance.
比较六种风险评分系统在评估急性缺血性卒中后发生卒中相关性肺炎（SAP）患者时的区分度和校准度。
验证队列来自第三次中国国家卒中登记。根据疾病控制与预防中心医院获得性肺炎的标准诊断SAP。采用受试者工作特征曲线下面积（AUROC）和Hosmer-Lemeshow拟合优度检验来评估区分度和校准度。
本研究共纳入12071例患者，其中606例（5.02%）在缺血性卒中后被诊断为院内SAP。六种临床评分的AUROC范围为0.660至0.752。在两两比较中，AIS-APS评分（0.752，95%CI = 0.730 - 0.773，P < 0.001）显示出比其他风险模型更好的区分度，但PASS评分除外。AIS-APS评分在缺血性卒中后院内SAP的Cox和Snell值最大。在亚组分析中，在61岁以上的患者中，除小血管病外的所有TOAST亚型、住院时间超过8天、男性和女性、按入院NIHSS评分和发病至入院时间分层的不同组中，AIS-APS评分在急性缺血性卒中后SAP方面显示出比其他风险模型更好的区分度。
我们的研究比较了权氏肺炎评分、A2DS2评分、PANTHERIS评分、AIS-APS评分、ISAN评分和PASS评分在识别SAP中的区分度和校准度；其中，AIS-APS评分表现最佳。
