Stroke-associated pneumonia (SAP) represents a frequent and serious complication following acute stroke that adversely affects patient recovery, and existing knowledge has identified various clinical risk factors for its development. However, comprehensive analysis integrating clinical parameters with advanced neuroimaging data to identify novel risk factors and quantify SAP’s impact on functional outcomes remains limited, creating gaps in our understanding of prevention strategies and prognostic assessment. Therefore, we analyzed data from the iBioStroke project participants, examining thirty-four variables available within 48 h of stroke onset to determine SAP incidence, comprehensive risk factors, and effects on 90-day functional outcomes (modified Rankin Scale 0–2 vs. 3–6). Among 797 patients with complete ischemic core volume and penumbra volume data, SAP occurred in 15.9% of cases. Risk factors included older age, higher pre-stroke mRS, neurological deterioration within 24 h after stroke, larger inital ischemic core and penumbra volumes, more severe global cortical atrophy, causative stroke treatment, higher white blood cell (WBC) count, elevated C-reactive protein and higher glucose levels. At 90 days, favorable outcomes were associated with younger age, lower pre-stroke mRS, neurological improvement within 24 h after stroke, smaller initial ischemic core and penumbra volumes, lower WBC count, and absence of SAP and urinary tract infection. Consequently, the absence of SAP demonstrated the strongest association with favorable outcomes (OR = 0.23; 95% CI: 0.13–0.39), establishing it as a critical determinant of post-stroke recovery. Notably, ischemic core and penumbra volumes emerged as novel factors influencing SAP risk, expanding beyond traditional clinical predictors. These findings thus highlight potentially modifiable clinical and imaging parameters that may guide early prevention strategies, providing a comprehensive framework for improving post-stroke outcomes through targeted SAP prevention interventions.
Dec‐Ćwiek et al. (Wed,) studied this question.