TY - JOUR
T1 - Temporal Profile of Pneumonia after Stroke
AU - de Jonge, Jeroen C.
AU - van de Beek, Diederik
AU - Lyden, Patrick
AU - Brady, Marian C.
AU - Bath, Philip M.
AU - Bart van der Worp, H.
N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and publication of this article: Dr de Jonge is funded by the European Union’s Horizon, 2020 research and innovation programme (grant no. 634809). Publisher Copyright: © 2021 The Authors.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - BACKGROUND AND PURPOSE: The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its association with poor outcome at several time points to identify the most optimal period for testing pneumonia prevention strategies. METHODS: We analyzed individual patient data stored in the VISTA (Virtual International Stroke Trials Archive) from randomized acute stroke trials with an inclusion window up to 24 hours after stroke onset and assessed the occurrence of pneumonia in the first 90 days after stroke. Adjusted odds ratios and hazard ratios were calculated for the association between pneumonia and poor outcome and death by means of logistic and Cox proportional hazard regression, respectively, at different times of follow-up. RESULTS: Of 10821 patients, 1017 (9.4%) had a total of 1076 pneumonias. Six hundred eighty-nine (64.0%) pneumonias occurred in the first week after stroke. The peak incidence was on the third day and the median time of onset was 4.0 days after stroke (interquartile range, 2–12). The presence of a pneumonia was associated with an increased risk of poor outcome (adjusted odds ratio, 4.8 [95% CI, 3.8–6.1]) or death (adjusted hazard ratio, 4.1 [95% CI, 3.7–4.6]). These associations were present throughout the 90 days of follow-up. CONCLUSIONS: Two out of 3 pneumonias in the first 3 months after stroke occur in the first week, with a peak incidence on the third day. The most optimal period to assess pneumonia prevention strategies is the first 4 days after stroke. However, pneumonia occurring later was also associated with poor functional outcome or death. GRAPHIC ABSTRACT: A graphic abstract is available for this article.
AB - BACKGROUND AND PURPOSE: The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its association with poor outcome at several time points to identify the most optimal period for testing pneumonia prevention strategies. METHODS: We analyzed individual patient data stored in the VISTA (Virtual International Stroke Trials Archive) from randomized acute stroke trials with an inclusion window up to 24 hours after stroke onset and assessed the occurrence of pneumonia in the first 90 days after stroke. Adjusted odds ratios and hazard ratios were calculated for the association between pneumonia and poor outcome and death by means of logistic and Cox proportional hazard regression, respectively, at different times of follow-up. RESULTS: Of 10821 patients, 1017 (9.4%) had a total of 1076 pneumonias. Six hundred eighty-nine (64.0%) pneumonias occurred in the first week after stroke. The peak incidence was on the third day and the median time of onset was 4.0 days after stroke (interquartile range, 2–12). The presence of a pneumonia was associated with an increased risk of poor outcome (adjusted odds ratio, 4.8 [95% CI, 3.8–6.1]) or death (adjusted hazard ratio, 4.1 [95% CI, 3.7–4.6]). These associations were present throughout the 90 days of follow-up. CONCLUSIONS: Two out of 3 pneumonias in the first 3 months after stroke occur in the first week, with a peak incidence on the third day. The most optimal period to assess pneumonia prevention strategies is the first 4 days after stroke. However, pneumonia occurring later was also associated with poor functional outcome or death. GRAPHIC ABSTRACT: A graphic abstract is available for this article.
KW - Death
KW - Pneumonia
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85122412686&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/STROKEAHA.120.032787
DO - https://doi.org/10.1161/STROKEAHA.120.032787
M3 - Article
C2 - 34517764
SN - 0039-2499
VL - 53
SP - 53
EP - 60
JO - Stroke
JF - Stroke
IS - 1
ER -