Combined Utility Of Lymphocyte-to-Monocyte Ratio And A~2DS~2 Score For Predicting Stroke-Associated Pneumonia

Objective:To analyze the incidence and risk factors of Stroke-Associated Pneumonia(SAP)in patients with Acute Ischemic Stroke(AIS)and explore the predictive value of combination of Lymphocyte-to-Monocyte Ratio(LMR)and A2DS2 score for SAP.In order to provide a scientific evidence for early intervention in stroke patients,reduce the incidence of SAP and improve the clinical outcome of patients with AIS.Methods:This study was divided into two parts.The first part was the retrospective study: 189 patients with AIS were admitted to First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2014 to June 2016.The subjects were divided into SAP group and non-SAP group according to SAP diagnostic criteria.The medical records were extracted:1,basic information: gender,age;history of present illness: dysphagia,atrial fibrillation,disturbance of consciousness;past history: hypertension,diabetes,coronary heart disease,history of stroke,history of lung disease;personal history: smoking,drinking,hyperlipidemia,hypoproteinemia;the time of stroke onset,the time of pneumonia onset,prestroke independence,NIHSS score at admission.2,laboratory indicators: white blood cell count,neutrophil count,lymphocyte count,monocyte count,glycated hemoglobin,glucose,total protein,albumin,total cholesterol,triglycerides.3,imaging data: type of cerebral infarction lesions,diagnosis of X-ray.Data were recoreded into excel to create a database.Data analysis was performed using SPSS 20.0 software,and the description of the measurement data was ?x±S,and the count data with rate(%).Univariate analysis for risk factors of SAP.Independent samples t test was adapted to compare white blood cell(WBC),neutrophil(N),lymphocyte(L),monocyte(M),Neutrophil-to-Lymphocyte Ratio(NLR)and LMR.Preliminary analysis risk factors and independent predictors for SAP.In the second part,based on the results of the first part,a prospective study was conducted:72 patients with AIS admitted to hospital from August 2016 to December 2018 were collected to investigate the incidence and risk factors of stroke-associated pneumonia in our hospital.Patient information was collected same with retrospective study.Record whether the pneumonia occurred within 7 days after admission.The subjects were divided into SAP group and non-SAP group according to SAP diagnostic criteria.SPSS 20.0 software was used for data analysis.Univariate analysis and multivariate analysis for risk factors of SAP.Independent samples t test were used to compare WBC,N,L,M,NLR and LMR between two groups.LMR,NLR,A2DS2 score and ISAN score were used to predict the incidence of SAP in AIS patients by Receiver Operating Characteristic(ROC)curve.The ability to predict SAP of NLR,LMR,A2DS2 score,and ISAN score was compared by calculating the Area Under Curve(AUC),Yoden index,sensitivity,and specificity.Further verify the results of the retrospective study and explore whether the combination of LMR and A2DS2 score can improve the predictive value of SAP in patients with AIS.The test level is α=0.05.Results:1 In the retrospective study,the incidence of SAP was 36.0%.Age,dysphagia,disturbance of consciousness,high blood pressure,prestroke independence are risk factors for SAP.LMR,NLR,A2DS2 score,and ISAN score are predictors of SAP.2 The incidence of SAP in the prospective study was 47.2%.Age,dysphagia,systolic blood pressure,albumin,and globulin are risk factors for SAP.LMR,NLR,A2DS2 score,and ISAN score are predictors of SAP.The combination of LMR and A2DS2 score showed an area under the ROC curve of 0.728,a sensitivity of 85.3%,and a specificity of 57.9%.Conclusion:1 age,dysphagia,disturbance of consciousness,high blood pressure,prestroke independence,serum albumin,globulin are risk factors for stroke-associated pneumonia.2 LMR,NLR,A2DS2 score,and ISAN score are predictors of SAP.3 The combination of LMR and A2DS2 score can improve the ability to predict SAP with a better predictive value for stroke-associated pneumonia.