title: External validation of the A2DS2 score to predict stroke-associated pneumonia in a Chinese population: a prospective cohort study.
abstract: OBJECTIVE
  The A2DS2 score was recently developed from the Berlin Stroke Registry for predicting in-hospital pneumonia after acute ischemic stroke and performed well in an external validation in the North-west Germany Stroke Registry. It could be a useful tool for risk stratification in clinical practice or stroke trials. We aimed to prospectively validate the predictive value of A2DS2 score in a Chinese stroke population.
  
  
  METHODS
  The prognostic model was used to predict stroke-associated pneumonia (SAP) from Henan Province Stroke Registry (HNSR) in which data were prospectively collected. The receiver-operating characteristic curves were plotted, and the C statistics were calculated to assess the discrimination ability. The Hosmer-Lemeshow goodness-of-fit test and the plot of observed versus predicted SAP risk were used to assess model calibration.
  
  
  RESULTS
  Among 1142 eligible patients, the overall in-hospital SAP was 18.8%, which ranged from 9.0% in patients with lower A2DS2 scores (0-4) to 65.0% in those with higher scores of 5 to 10 (P for trend <0.001). The C statistic was 0.836 (95% confidence interval, 0.803-0.868) through the A2DS2 score, suggesting excellent discrimination in the HNSR. The A2DS2 score also showed excellent calibration (Cox and Snell R2 = 0.243) in the external validation sample from the HNSR.
  
  
  CONCLUSIONS
  The A2DS2 score could reliably predict in-hospital SAP in Chinese stroke patients. It might be helpful for the assessment of increased risk monitoring and prophylactic treatment in identified high-risk patients for SAP in clinical routine.
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
authors.forename: Yapeng
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Song
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Fang
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
authors.forename: Yuming
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000473:pathology