Key result
A prediction model combining the A2DS2 score with clinical and neuroimaging factors better predicted stroke-associated pneumonia than the A2DS2 scale alone (C-statistic 0.84 vs 0.76).
Why the study?
To investigate predictors of stroke-associated pneumonia and poor functional outcome in hyperacute cerebral infarction by combining clinical factors, laboratory tests, and neuroimaging features.
Does a combined model of clinical and neuroimaging factors better predict stroke-associated pneumonia and poor functional outcome in patients with hyperacute cerebral infarction compared to the A2DS2 scale?
Cohort (n=205)
Does a combined model of clinical and neuroimaging factors better predict stroke-associated pneumonia and poor functional outcome in patients with hyperacute cerebral infarction compared to the A2DS2 scale?
Effect estimate: C-statistic 0.84 (95% CI 0.78-0.90)
Combining neuroimaging features with clinical factors improves the prediction of stroke-associated pneumonia and poor functional outcomes in patients with hyperacute cerebral infarction compared to the A2DS2 score alone.
Enhanced pneumonia prediction may enable targeted prophylaxis in acute stroke; extends A2DS2 with clinical and neuroimaging integration.
Objective To investigate the predictors of stroke-associated pneumonia (SAP) and poor functional outcome in patients with hyperacute cerebral infarction (HCI) by combining clinical factors, laboratory tests and neuroimaging features. Methods We included 205 patients with HCI from November 2018 to December 2019. The diagnostic criterion for SAP was occurrence within 7 days of the onset of stroke. Poor outcome was defined as a functional outcome based on a 3-months MRS score >3. The relationship of demographic, laboratory and neuroimaging variables with SAP and poor outcome was investigated using univariate and multivariate analyses. Results Fifty seven (27.8%) patients were diagnosed with SAP and 40 (19.5%) developed poor outcomes. A 2 DS 2 score (OR = 1.284; 95% CI: 1.048–1.574; P = 0.016), previous stroke (OR = 2.630; 95% CI: 1.122–6.163; P = 0.026), consciousness (OR = 2.945; 95% CI: 1.514–5.729; P < 0.001), brain atrophy (OR = 1.427; 95% CI: 1.040–1.959; P = 0.028), and core infarct volume (OR = 1.715; 95% CI: 1.163–2.528; P = 0.006) were independently associated with the occurrence of SAP. Therefore, we combined these variables into a new SAP prediction model with the C-statistic of 0.84 (95% CI: 0.78–0.90). Fasting plasma glucose (OR = 1.404; 95% CI: 1.202–1.640; P < 0.001), NIHSS score (OR = 1.088; 95% CI: 1.010–1.172; P = 0.026), previous stroke (OR = 4.333; 95% CI: 1.645–11.418; P = 0.003), SAP (OR = 3.420; 95% CI: 1.332–8.787; P = 0.011), basal ganglia-dilated perivascular spaces (BG-dPVS) (OR = 2.124; 95% CI: 1.313–3.436; P = 0.002), and core infarct volume (OR = 1.680; 95% CI: 1.166–2.420; P = 0.005) were independently associated with poor outcome. The C-statistic of the outcome model was 0.87 (95% CI: 0.81–0.94). Furthermore, the SAP model significantly improved discrimination and net benefit more than the A 2 DS 2 scale, with a C-statistic of 0.76 (95% CI: 0.69–0.83). Conclusions After the addition of neuroimaging features, the models exhibit good differentiation and calibration for the prediction of the occurrence of SAP and the development of poor outcomes in HCI patients. The SAP model could better predict the SAP, representing a helpful and valid tool to obtain a net benefit compared with the A 2 DS 2 scale.
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Yu et al. (2022) conducted a cohort in Hyperacute cerebral infarction (n=205). SAP prediction model (A2DS2 score combined with clinical and neuroimaging factors) vs. A2DS2 scale was evaluated on Stroke-associated pneumonia (SAP) within 7 days (C-statistic 0.84, 95% CI 0.78-0.90). A prediction model combining the A2DS2 score with clinical and neuroimaging factors better predicted stroke-associated pneumonia than the A2DS2 scale alone (C-statistic 0.84 vs 0.76).
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