Do We Need to Distinguish Thrombolysis and Nonthrombolysis Patients When Applying Stroke-Associated Pneumonia Predicting Scores? An External Validation from a 2-Center Database
Jiao Jiao, Leiyu Geng, Zhijun Zhang
Medical School of Southeast University, Nanjing, Jiangsu, China (mainland)
Med Sci Monit 2020; 26:e924129
Available online: 2020-07-21
Due to the lack of validation for predictive scoring of stroke-associated pneumonia in both thrombolysis- and nonthrombolysis-treated ischemic stroke (IS) patients, this study aimed to evaluate 4 scoring methods in the 2 subgroups.
MATERIAL AND METHODS: The CerebroVascular Database Project database included data from patients with cerebral IS that were admitted in 2 hospitals from February 2016 to January 2018. A total of 138 thrombolysis-treated and 138 nonthrombolysis-treated IS patients were enrolled. Area under receiver operating characteristic curves (AUROC) were performed to examine the discrimination of the 4 scores, and Hosmer-Lemeshow test was used to evaluate the goodness of fit.
RESULTS: The incidence of stroke-associated pneumonia was 24.8%. The thrombolysis and nonthrombolysis subgroups were not significantly different with regard to sex, present smoking, chronic obstructive pulmonary disease history, atrial fibrillation history, blood pressure, or glucose level on admission. However, significant differences were found in National Institutes of Health Stroke Scale scores (P<0.001), Glascow Coma Scale scores (P<0.001), Oxfordshire Community Stroke Project classification (P<0.001), dysphagia (P<0.001), and white blood cell counts (P=0.039). The AUROC for the Age, Atrial fibrillation, Dysphagia, male Sex, stroke Severity, National Institutes of Health Stroke Scale; Preventive ANtibacterial THERapy in acute Ischemic Stroke; Acute Ischemic Stroke-Associated Pneumonia Score (AIS-APS); and Independence, Sex, Age, National Institutes of Health Stroke Scale scores in total population were 0.80 (0.74-0.84), 0.75 (0.69-0.80), 0.80 (0.76-0.85), and 0.76 (0.71-0.81). The goodness of fit was 0.22, 0.22, 0.27, and 0.17, respectively. The AUROC of 4 scores between subgroups were not statistically significant.
CONCLUSIONS: The AIS-APS had the highest AUC and goodness of fit in our population. All 4 scores can be applied regardless of whether thrombolysis has been performed on patients.
Keywords: Brain Ischemia, Pneumonia, Aspiration, Stroke, Thrombolytic Therapy