Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke
Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke
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DOI：
10.1212/wnl.0b013e31823152b1
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发表时间：
2011-10-01
期刊：
影响因子：
9.9
通讯作者：
Saposnik, G.
中科院分区：
文献类型：
--
作者：
Finlayson, O.;Kapral, M.;Saposnik, G.
目的：肺炎是脑卒中后最常见的并发症。虽然已经报道了几个危险因素，但常见合并症在肺炎发展中的作用尚未得到很好的确定。此外，关于肺炎对卒中结局的影响，文献存在差异。方法：这是一项多中心回顾性队列研究，包括2003年7月至2007年3月参加加拿大卒中网络登记的区域卒中中心的连续缺血性卒中患者。肺炎被定义为中风后30天内发生的并发症，并经影像学证实。主要结局指标为调整后的30天死亡率。次要结局包括调整后的7天和365天死亡率、住院情况、住院时间和出院时的修正Rankin评分。我们还评估了有组织的卒中护理对肺炎发展和死亡率的影响。结果：总共有8251名患者被纳入研究。卒中相关性肺炎587例（7.1%）。肺炎增加了30天死亡率（优势比[OR] 2.2[95%可信区间（CI） 1.8-2.7]）和1年死亡率（优势比[OR] 3.0 [95% CI 2.5-3.7]），但7天死亡率没有增加。肺炎与不良的功能预后相关。获得更多有组织的住院治疗导致30天死亡率降低（OR 0.50 [95% CI 0.41-0.61]）。年龄、男性、中风严重程度、吞咽困难、慢性阻塞性肺疾病、冠状动脉疾病、非腔隙性缺血性中风和入院前依赖是肺炎的独立预测因素。结论：卒中后肺炎的发生与30天和1年的死亡率、住院时间延长和出院时的依赖性有关。接受更多中风住院治疗的患者肺炎后死亡率降低。神经病学(R) 2011；77:1338 - 1345
Objectives: Pneumonia is the most common medical complication after stroke. Although several risk factors have been reported, the role of common comorbidities in the development of pneumonia is not well established. Moreover, there is discrepancy in the literature regarding the impact of pneumonia on stroke outcomes.Methods: This is a multicenter retrospective cohort study including consecutive patients with ischemic stroke admitted to Regional Stroke Centers participating in the Registry of Canadian Stroke Network in July 2003-March 2007. Pneumonia was defined as a complication that occurred within the first 30 days of the stroke and was confirmed radiographically. The main outcome measure was adjusted 30-day mortality. Secondary outcomes were adjusted 7- and 365-day mortality, institutionalization, length of stay, and modified Rankin score on discharge. We also assessed the impact of organized stroke care on pneumonia development and mortality.Results: Overall, 8,251 patients were included in the study. Stroke-associated pneumonia was observed in 587 patients (7.1%). Pneumonia increased 30-day (odds ratio [OR] 2.2 [95% confidence interval (CI) 1.8-2.7]) and 1-year mortality (OR 3.0 [95% CI 2.5-3.7]), but not 7- day mortality. Pneumonia was associated with poor functional outcome. Higher access to organized inpatient care resulted in a reduction of 30-day mortality (OR 0.50 [95% CI 0.41-0.61]). Older age, male sex, stroke severity, dysphagia, chronic obstructive pulmonary disease, coronary artery disease, nonlacunar ischemic stroke, and preadmission dependency were independent predictors of pneumonia.Conclusions: Development of pneumonia after stroke was associated with mortality at 30 days and 1 year, longer length of stay, and dependency at discharge. Patients who received more inpatient stroke services had reduced mortality after pneumonia. Neurology (R) 2011;77:1338-1345