title: Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study.
abstract: Stroke-associated pneumonia is a frequent complication after stroke associated with poor outcome. Dysphagia is a known risk factor for stroke-associated pneumonia but accumulating evidence suggests that stroke induces an immunodepressive state increasing susceptibility for stroke-associated pneumonia. We aimed to confirm that stroke-induced immunodepression syndrome is associated with stroke-associated pneumonia independently from dysphagia by investigating the predictive properties of monocytic HLA-DR expression as a marker of immunodepression as well as biomarkers for inflammation (interleukin-6) and infection (lipopolysaccharide-binding protein). This was a prospective, multicenter study with 11 study sites in Germany and Spain, including 486 patients with acute ischemic stroke. Daily screening for stroke-associated pneumonia, dysphagia and biomarkers was performed. Frequency of stroke-associated pneumonia was 5.2%. Dysphagia and decreased monocytic HLA-DR were independent predictors for stroke-associated pneumonia in multivariable regression analysis. Proportion of pneumonia ranged between 0.9% in the higher monocytic HLA-DR quartile (≥21,876 mAb/cell) and 8.5% in the lower quartile (≤12,369 mAb/cell). In the presence of dysphagia, proportion of pneumonia increased to 5.9% and 18.8%, respectively. Patients without dysphagia and normal monocytic HLA-DR expression had no stroke-associated pneumonia risk. We demonstrate that dysphagia and stroke-induced immunodepression syndrome are independent risk factors for stroke-associated pneumonia. Screening for immunodepression and dysphagia might be useful for identifying patients at high risk for stroke-associated pneumonia.
authors.affiliation: 1 NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.|2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoffmann
authors.affiliation: 3 Department of Neurology, St.-Josefs Krankenhaus Potsdam, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Harms
authors.affiliation: 1 NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Ulm
authors.affiliation: 4 Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany.
authors.forename: Darius G
authors.initials: DG
authors.lastname: Nabavi
authors.affiliation: 5 Department of Neurology, Vivantes Auguste Viktoria Klinikum, Berlin, Germany.
authors.forename: Bruno-Marcel
authors.initials: BM
authors.lastname: Mackert
authors.affiliation: 6 Department of Neurology, Unfallkrankenhaus Berlin, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Schmehl
authors.affiliation: 7 Department of Neurology, Jüdisches Krankenhaus Berlin, Germany.|8 Center for Stroke Research (CSB), Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Jungehulsing
authors.affiliation: 9 Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Montaner
authors.affiliation: 9 Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bustamante
authors.affiliation: 4 Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany.
authors.forename: Marcella
authors.initials: M
authors.lastname: Hermans
authors.affiliation: 5 Department of Neurology, Vivantes Auguste Viktoria Klinikum, Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Hamilton
authors.affiliation: 2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Jos
authors.initials: J
authors.lastname: Göhler
authors.affiliation: 10 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany.|11 Clinical Trial Center Würzburg, University Hospital Würzburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Malzahn
authors.affiliation: 10 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany.|12 Comprehensive Heart Failure Center, University of Würzburg, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Malsch
authors.affiliation: 10 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany.|11 Clinical Trial Center Würzburg, University Hospital Würzburg, Germany.|12 Comprehensive Heart Failure Center, University of Würzburg, Germany.
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.affiliation: 13 Department of Immunology, Charité - Universitätsmedizin Berlin, Germany.|14 Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meisel
authors.affiliation: 1 NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.|2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.|8 Center for Stroke Research (CSB), Charité - Universitätsmedizin Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Meisel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology* / Q000276:immunology; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D015850:Interleukin-6 / Q000032:analysis / Q000276:immunology; D008264:Macrophages / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000276:immunology
chemical_list: D006684:HLA-DR Antigens; D015850:Interleukin-6
keywords: Acute stroke; immunology; infection; inflammation; macrophages