Risk Factors Of Stroke Associated Pneumonia And Application Of A2DS2 Scoring For Stroke Associated Pneumonia

Objective: Stroke is one of the three human major causes of death which has the characteristics of high incidence mortality and morbidity. Complication is one of the reason of death. Infection is one of the most common complication of acute stroke. It is also the leading cause of illness and death in patients with stroke. At present, a large number of studies have shown that the immunodepression after stroke which can lead to stroke associated pneumonia. Whether some risk factors are independent risk factors for stroke associated pneumonia and the specific mechanism is still unclear. In 2012 Hoffmann and some scholars made A2DS2 standard to evaluate the SAP. The assessment is effective and convenient, it causes the attention of scholars. But there is little report about the specificity and sensitivity of A2DS2 score for SAP. Therefore this study through the analysis of the risk factors of stroke associated pneumonia and investigate the relationship between with SAP. Evaluate A2DS2 score in SAP. In order to take positive and effective intervention measures, improve the life quality of patients and the prognosis.Methods:(1)Collect 396 patients with acute stroke who have been hospitalized in neurology intensive care unit of the First Affiliated Hospital of Dalian Medical University from March 2013 to March 2014(2)All the patients are following the standards and Exclusion criterion(3)Observational index:General Information: Age, Gender, Anamnesis(hypertension, heart disease, diabetes, past pulmonary diseases, stroke history) smoking history,The main clinical data:Length of stay;Dysphagia;Lien nasogastric;Whether using acid inhibitors;The NIHSS scores when be hospitalized;The A2DS2 score: According to the scale made by Hoffmann(4)Statistical analysis: Using SPSS20.0 software for data processing and analysis, All data used single factor analysis respectively and Logistic Regression analysis correlation of stroke risk factors of pneumonia. Using the ROC(receiver operating characteristic) evaluate the A2DS2, Calculate the area under the curve(AUC) and the sensitivity and specificity.Result:This study collected 396 patients with access standard, According to their risk for stroke associated pneumonia after stroke is divided into pneumonia(SAP) group(218) and the non-pneumonia group(n = 178)1. General character:The general character of pneumonia(SAP) group and the non-pneumonia group, According to the single factor analysis: Results show: Age, hypertension, heart disease, diabetes, past pulmonary diseases, stroke history, smoking history, The difference is statistically significant(P<0.05).2. The main clinical data:The main clinical data of pneumonia(SAP) group and the non-pneumonia group, According to the single factor analysis: Results show: Length of stay;Dysphagia;Lien nasogastric;Whether using acid inhibitors;The NIHSS scores when be hospitalized; The difference is statistically significant(P<0.05).3. Analysis of risk factors:Using Logistic Regression analysis evaluate the significant risk factors: Results show: diabetes, past pulmonary diseases, stroke history, smoking history, Length of stay;Dysphagia;Lien nasogastric;Whether using acid inhibitors;The NIHSS scores when be hospitalized; These risk factors are the independent risk factors of SAP.4. A2DS2 score for stroke-associated pneumonia.The ROC curve shows: the area under the curve(AUC) is 0.821( P<0.001) which indicates A2DS2 score for SAP prediction accuracy is very high. Evaluate the sensitivity and specificity of every score, we can find that when the score is 5 points, the sensitivity is 0.697 and specificity is 0.831, the accuracy is the best, the point is the best forecast point.Conclusion:1. Age, hypertension, heart disease, diabetes, past pulmonary diseases, stroke history, smoking history, Length of stay;Dysphagia;Lien nasogastric;Whether using acid inhibitors;The NIHSS scores when be hospitalized; The difference is statistically significant2.Diabetes, past pulmonary diseases, stroke history, smoking history, Length of stay;Dysphagia;Lien nasogastric;Whether using acid inhibitors;The NIHSS scores when be hospitalized; These risk factors are the independent risk factors of SAP.3.The A2DS2 score can be well used for predicting the occurrence of stroke associated pneumonia and have important significant in the prevention of stroke-associated pneumonia.