title: Risk score to predict hospital-acquired pneumonia after spontaneous intracerebral hemorrhage.
abstract: OBJECTIVE
  We aimed to develop a risk score (intracerebral hemorrhage-associated pneumonia score, ICH-APS) for predicting hospital-acquired stroke-associated pneumonia (SAP) after ICH.
  
  
  METHODS
  The ICH-APS was developed based on the China National Stroke Registry (CNSR), in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. Variables routinely collected at presentation were used for predicting SAP after ICH. For testing the added value of hematoma volume measure, we separately developed 2 models with (ICH-APS-B) and without (ICH-APS-A) hematoma volume included. Multivariable logistic regression was performed to identify independent predictors. The area under the receiver operating characteristic curve (AUROC), Hosmer-Lemeshow goodness-of-fit test, and integrated discrimination index were used to assess model discrimination, calibration, and reclassification, respectively.
  
  
  RESULTS
  The SAP was 16.4% and 17.7% in the overall derivation (n=2998) and validation (n=2000) cohorts, respectively. A 23-point ICH-APS-A was developed based on a set of predictors and showed good discrimination in the overall derivation (AUROC, 0.75; 95% confidence interval, 0.72-0.77) and validation (AUROC, 0.76; 95% confidence interval, 0.71-0.79) cohorts. The ICH-APS-A was more sensitive for patients with length of stay >48 hours (AUROC, 0.78; 95% confidence interval, 0.75-0.81) than those with length of stay <48 hours (AUROC, 0.64; 95% confidence interval, 0.55-0.73). The ICH-APS-A was well calibrated (Hosmer-Lemeshow test) in the derivation (P=0.20) and validation (P=0.66) cohorts. Similarly, a 26-point ICH-APS-B was established. The ICH-APS-A and ICH-APS-B were not significantly different in discrimination and reclassification for SAP after ICH.
  
  
  CONCLUSIONS
  The ICH-APSs are valid risk scores for predicting SAP after ICH, especially for patients with length of stay >48 hours.
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Ruijun
authors.initials: R
authors.lastname: Ji
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Haipeng
authors.initials: H
authors.lastname: Shen
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Yuesong
authors.initials: Y
authors.lastname: Pan
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Wanliang
authors.initials: W
authors.lastname: Du
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Penglian
authors.initials: P
authors.lastname: Wang
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Gaifen
authors.initials: G
authors.lastname: Liu
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.).
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: From the Tiantan Comprehensive Stroke Center, Tiantan Hospital, Capital Medical University, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); China National Clinical Research Center for Neurological Diseases, Beijing, China (R.J., Y.P., W.D., P.W., G.L., Yilong Wang, H.L., X.Z., Yongjun Wang); and Department of Statistics and Operation Research, University of North Carolina, Chapel Hill (H.S.). yongjunwang1962@gmail.com.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis*; D002681:China; D003428:Cross Infection / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis
keywords: cerebral hemorrhage; forecasting; pneumonia