title: Leukoaraiosis is associated with pneumonia after acute ischemic stroke.
abstract: BACKGROUND
  Stroke-associated pneumonia (SAP) is common in patients with acute ischemic stroke, and several risk factors have been reported. However, the relationship between underlying leukoaraiosis (LA) and SAP has not been addressed.
  
  
  METHODS
  We collected consecutive patients with acute ischemic stroke within 24 h of symptom onset. SAP was defined as the lower respiratory tract infection within the first 7 days after stroke onset, according to the modified Centers for Disease Control and Prevention criteria. LA was graded using the Fazekas scale in both the periventricular and subcortical areas. We evaluated LA burden by summing the grade and dichotomized into mild LA (0-2) or severe LA (3-6). Relationship between LA and SAP was analyzed by binary logistic regression analysis with variables of P < 0.05 in univariate analysis.
  
  
  RESULTS
  Three hundred eight consecutive patients were enrolled, and SAP developed in 44 patients (14%). Univariate analysis revealed that SAP correlated with age, initial NIHSS score, atrial fibrillation, impaired consciousness, dysphagia, severe LA and hyperlipidemia. On multivariate analysis, severe LA [adjusted OR (aOR) = 4.41, 95% CI = 2.04-9.55, P < 0.001 remained independent predictors of SAP after adjusted confounders.
  
  
  CONCLUSIONS
  In this study, LA was an independent predictor of SAP. This observation needs to be confirmed in suitably-designed, prospective studies.
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, South Korea.
authors.forename: Ki-Woong
authors.initials: KW
authors.lastname: Nam
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, South Korea.
authors.forename: Hyung-Min
authors.initials: HM
authors.lastname: Kwon
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea.
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Lim
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, South Korea. mercades@snu.ac.kr.
authors.forename: Yong-Seok
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology
keywords: Cerebral infarction; Leukoaraiosis; Pneumonia