Bacterial pneumonia following acute ischemic stroke.
BACKGROUND
The most common serious complication following acute ischemic stroke is pneumonia, which may increase mortality and worsen clinical outcomes. The purpose of this study was to investigate the predictors of 30-day mortality in patients with pneumonia following acute ischemic stroke.


METHODS
From June 2006 to May 2011, we retrospectively included 51 patients with pneumonia following acute ischemic stroke. We analyzed the clinical features, microbiologic data, and outcomes. Predictors of 30-day mortality were investigated by univariate and multivariate analysis.


RESULTS
The acute ischemic strokes were caused by large-artery atherosclerosis in 37 (72.5%) of the 51 patients. We found that the most common pathogen responsible for poststroke pneumonia was Klebsiella pneumoniae, followed by Pseudomonas aeruginosa and Escherichia coli. Ultimately, 12 patients died of progressive sepsis due to pneumonia after the acute ischemic stroke. The 30-day mortality rate was 23.5%. In the univariate analysis, patients who died within 30 days had higher National Institutes of Health Stroke Scale scores, higher CURB-65 scores, elevated instability of hemodynamic status, and lower Glasgow Coma Scale (GCS) scores. In Cox regression analysis, a GCS score of <9 on the day of pneumonia onset was only significant indicator for 30-day mortality (hazard ratio, 6.72; 95% confidence interval, 2.12-21.30, p = 0.001).


CONCLUSIONS
Pneumonia after acute ischemic stroke is a severe complication. Once stroke-related pneumonia develops, neurologic assessment, CURB-65 score, and shock can be used to predict the ultimate prognosis.
Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Li-Fu
LF
Chen
Cheng-Yu
CY
Chang
Li-Cho
LC
Hsu
Ping-Huang
PH
Tsai
Shu-Ju
SJ
Chang
Shih-Chieh
SC
Chang
Mei-Kang
MK
Yuan
Yi-Chun
YC
Lai
Yu-Chang
YC
Liu
Wei-Shu
WS
Wang
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*