Development of a Clinical Score (A2DS2) to Predict Pneumonia in Acute Ischemic Stroke
Development of a Clinical Score (A2DS2) to Predict Pneumonia in Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.112.653055
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发表时间：
2012-10-01
期刊：
影响因子：
8.3
通讯作者：
Heuschmann, Peter Ulrich
中科院分区：
文献类型：
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作者：
Hoffmann, Sarah;Malzahn, Uwe;Heuschmann, Peter Ulrich
背景和目的-卒中后肺炎是一种潜在的可预防的并发症，与预后不良相关。我们开发并外部验证了用于预测缺血性卒中后肺炎风险的预后评分。方法-基于德国柏林卒中登记入院后常规收集的临床数据，制定了预后评分。采用多变量Logistic回归分析研究了人口学、合并症和临床特征与卒中后肺炎的关系。卒中后肺炎的独立预测因素被转化为基于相应回归系数的积分系统。结果：2007至2009年间，柏林卒中登记处登记了15335名缺血性卒中患者。院内肺炎观察率为7.2%。对于卒中后肺炎的预测得分为10分(年龄=75岁=1，房颤=1，吞咽困难=2，男性=1，卒中严重程度，美国国立卫生研究院卒中评分0-4=0，5-15=3，>；=16=5；A(2)DS(2))。肺炎在0分患者中的比例为0.3%，在10分患者中为39.4%。得分表现出很好的判别力(C-统计学0.84；95%CI，0.83-0.85)和校准(McFadden R-2=0.21)。在由45085名缺血性中风患者组成的验证队列中，预测、区分和校准属性被重现。结论-基于常规可用数据，A(2)DS(2)评分是预测中风后肺炎的有效工具。A(2)DS(2)可用于指导临床常规高危患者的监测或肺炎的预防性管理。(笔划。2012；43：2617-2623。)
Background and Purpose-Poststroke pneumonia is a potentially preventable complication after stroke associated with poor outcome. We developed and externally validated a prognostic score for predicting risk of pneumonia after ischemic stroke.Methods-The prognostic score was developed based on clinical data routinely collected after admission from the Berlin Stroke Register, Germany. The association of demographics, comorbidities, and clinical characteristics with poststroke pneumonia was investigated using multivariable logistic regression analyses. Independent predictors of poststroke pneumonia were translated into a point scoring system based on the corresponding regression coefficients. The predictive properties of the developed prognostic score were externally validated using an independent data set from the Stroke Register Northwest-Germany.Results-Between 2007 and 2009, 15 335 patients with ischemic stroke were registered within the Berlin Stroke Register. The observed rate of pneumonia in hospital was 7.2%. A 10-point score was derived for prediction of poststroke pneumonia (Age >= 75 years=1, Atrial fibrillation=1, Dysphagia=2, male Sex=1, stroke Severity, National Institutes of Health Stroke Scale 0-4=0, 5-15=3, >= 16=5; A(2)DS(2)). The proportion of pneumonia varied between 0.3% in patients with a score of 0 point to 39.4% in patients with a score of 10 points. The score demonstrated excellent discrimination (C-statistic 0.84; 95% CI, 0.83-0.85) and calibration (McFadden R-2=0.21). Prediction, discrimination, and calibration properties were reproduced in the validation cohort consisting of 45 085 patients with ischemic stroke.Conclusions-The A(2)DS(2) score is a valid tool for predicting poststroke pneumonia based on routinely available data. A(2)DS(2) might be useful for guiding monitoring of high-risk patients or prophylactic pneumonia management in clinical routine. (Stroke. 2012; 43:2617-2623.)