By: Ham SongJin, Cha SonHyang, Choe UnHyok, Pak JaeYong, and Kim KumYong
1Researcher, Department of Medical Sciences, Pyongyang University of Medical Sciences, Pyongyang, Democratic People’s Republic of Korea
Objective: To determine the best scoring system among 5 scores (Pneumonia score, PANTHERIS, ISAN score, A2DS2, ACDD4) for prediction of pneumonia after acute haemorrhagic stroke in Stroke Centre. Subjects and Methods: We carried out retrospective study of 508 patients with acute haemorrhagic stroke admitted to Department of Neurology of Pyongyang medical university from January 1, 2018 to August 1, 2022. Demographic and clinical traits of patients were collected and analysed. We assessed the predictive validity of the scoring systems using receiver operating characteristic (ROC) curve analysis. Results: Among 5 scoring systems, the AUROC was largest in A2DS2 score (AUROC=0.935), and then ISAN score (AUROC=0.910, p=0.2254), Pneumonia score (AUROC=0.838, p=0.0008), ACDD4(AUROC=0.821, p=0.0003), PANTHERIS (AUROC=0.727, p<0.0001) respectively and significant differences were found between A2DS2 score and other scoring systems except ISAN score. Youden index (0.749), sensitivity (0.958), PPV (0.889) and NPV (0.915) of were highest in A2DS2 score and this result suggested that predictive ability A2DS2 score is higher than other scoring systems. The cutoff point was 7 in A2DS2, 11 in ISAN score, 4 in ACDD4 and 5 in PANTHERIS. Conclusion: A2DS2 score with 7 points as the cutoff point is best scoring system for prediction of pneumonia after acute haemorrhagic stroke. ISAN score is also favourable for prediction of pneumonia after acute haemorrhagic stroke with 11 points as the cutoff point.
Keywords: acute hemorrhagic stroke, predictive scoring system, pneumonia
Citation:
Refrences:
1. Vermeij FH, Scholte op Reimer WJ, de Man MP, van Oostenbrugge RJ, Franke CL, de Jong G, de Kort PL, Dippel DW. Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke: data from the Netherlands Stroke Survey.Cerebrovasc Dis2009,27:465-471.
2. Adam J. Friedant, BS,Brittany M. Gouse,BS,*Amelia K. Boehme,PhD, MSPH,†‡James E. Siegler,MD,xKaren C. Albright,DO, MPH,jj{#Dominique J. Monlezun,MPH,*Alexander J. George,BS,*Timothy Mark Beasley,PhD,**and Sheryl Martin-Schild,MD, PhD*. A Simple Prediction Score for Developing a Hospital-Acquired Infection after Acute Ischemic Stroke , Journal of Stroke and Cerebrovascular Diseases, Vol. 24, No. 3 (March), 2015: pp 680-686
3. Emily Brogan et al; Can’t swallow, can’t transfer, can’t toilet: Factors predicting infections in the first week post stroke, Journal of Clinical Neuroscience 22 (2015) 92–97
4. Nickson Mukapa et al; Incidence, risk factors and microbiological aetiology of urinary tract infections in admitted stroke patients at a teaching hospital in Zimbabwe: A prospective cohort study, Infection Prevention in Practice 4 (2022) 100210
5. Willeke F Westendorp1, Paul J Nederkoorn1, Jan-Dirk Vermeij1, Marcel G Dijkgraaf2 and Diederik van de Beek1,3*;Post-stroke infection: A systematic review and meta-analysis; Westendorpet al. BMC Neurology2011,11:110 http://www.biomedcentral.com/1471-2377/11/110
6. Maja Wästfelt1*, Yang Cao2,3 and Jakob O. Ström; Predictors of post-stroke fever and infections: a systematic review and meta-analysis; BMC Neuology, (2018) 18:49 https://doi.org/10.1186/s12883-018-1046-z
7. Satoshi Suda et al; Stroke‑associated infection independently predicts 3‑month poor functional outcome and mortality, Journal of Neurology (2018) 265:370–375 https://doi.org/10.1007/s00415-017-8714-6
8. Yi-Jing Yu, Wei-Chieh Weng, Feng-Chieh Su, Tsung-I Peng, Yu-Yi Chien, Chia-Lun Wu, Kuang-Yung Lee; Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke, Journal of Clinical Neuroscience 33 (2016) 124–128
9. Avinash Beharry et al; Predictive Factors of Swallowing Disorders and Bronchopneumonia in Acute Ischemic Stroke; Journal of Stroke and Cerebrovascular Diseases, Vol.&&, No.&&(&&), 2019:&&&& https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.04.025
10. S. Broadley et al; Predictors of prolonged dysphagia following acute stroke Journal of Clinical Neuroscience(2003)10(3), 300–305
11. Kasuya Y, Hargett JL, Lenhardt R, Heine MF, Doufas AG, Remmel KS, et al. An important feature of the ACDD4 score is that it has been derived using only non-ventilated stroke patients. Ventilator-associated pneumonia in critically ill stroke patients: Frequency, risk factors, and outcomes. Journal of critical care. 2011;26:273-279
12. Ji R, Shen H, Pan Y, Wang P, Liu G, Wang Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke, 2013;44:1303-1309.
13. Sandeep Kumar, MD; Sarah Marchina, PhD; Joseph Massaro, PhD; Wayne Feng, MS, MD; Sourabh Lahoti, MD; Magdy Selim, MD, PhD; Shoshana J. Herzig, MD, MPH. ACDD4 Score: A Simple Tool for Assessing Risk of Pneumonia after Stroke, Journal of the Neurological Sciences, 2016, 1~9
14. Yunlong Ding, Yazhou Yan, Jiali Niu, Yanrong Zhang, Zhiqun Gu, Ping Tang and Yan Liu; Braden scale for assessing pneumonia after acute ischaemic stroke , BMC Geriatrics(2019) 19:259 ,https://doi.org/10.1186/s12877-019-1269-x
15. Yang Li et al; Risk of stroke-associated pneumonia during hospitalization: predictive ability of combined A2DS2 score and hyperglycemia,BMC Neurology(2019) 19:298 https://doi.org/10.1186/s12883-019-1497-x
16. Hoffmann S, Malzahn U, Harms H, et al. Development of a clinical score (A2DS2) to predict pneumonia in acute ischemic stroke. Stroke J Cereb Circ. 2012 Oct;43(10):2617–23.
17. Kwon H-M, Jeong S-W, Lee S-H, Yoon B-W. The pneumonia score: a simple grading scale for prediction of pneumonia after acute stroke. Am J Infect Control. 2006 Mar;34(2):64–8.
18. Smith CJ, Bray BD, Hoffman A, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study . J Am Heart Assoc. 2015 Jan;4(1).
19. Ji R, Shen H, Pan Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke J Cereb Circ. 2013 May;44(5):1303–9
20. Harms H, Grittner U, Dr€ oge H, et al. Predicting poststroke pneumonia: the PANTHERIS score. Acta Neurol Scand 2013;128:178-184.
