The Predictive Value Of A~2DS~2 Score Combined With Blood Glucose For Acute Ischemic Stroke Associated Pneumonia

Objective:To explore whether the A~2DS~2 score combined with blood glucose can improve the predictive ability for risk of SAP in patients with acute ischemic stroke or not.And to provide a reliable and practical selection criteria for the further study of preventive treatment in high-risk patients with SAP.Methods:It was collected retrospectively that the data of patients with acute ischemic stroke admitted to the neurology department of the first hospital of Shanxi Medical University from January 2012 to December 2016.The information collected includes age,sex,atrial fibrillation,dysphagia,NIHSS score,admission blood glucose,fasting blood glucose and infarction location.Diagnostic criteria for SAP was one of the CDC criteria and the Manns criteria for all enrolled subjects.Calculated the adjusted OR of hyperglycemia and gave it a predictive point according to Hoffmann's criteria.Then added the point and the A~2DS~2 score together to develop a new score.It was analyzed and compared that the area under curve of receiver operating characteristics curve(AUCROC)of the A~2DS~2 score and the new score.AUC of less than 0.05,there is no predictive value.The higher the AUCROC,the better the predictive ability.And calculated the sensitivity and specificity of optimum cutoff point of the two scores.Significance was defined as a P value <0.05.Results:A total of 2552 eligible patients with acute ischemic stroke were enrolled in the study.Mean age was 61.9 years(SD 12.7).The incidence of SAP is 7.8%.The adjusted ORs of admission hyperglycemia(? 11.1mmol/L),fasting hyperglycemia(? 7.1mmol/L),admission or fasting hyperglycemia were 1.04(P=0.885),2.86(P<0.05),1.14(P=0.475),respectively.The fasting hyperglycemia was the independent predictive factor of SAP.And its adjusted OR was between 2 and 4,thus gave it 2 points.A new score was developed after added the points of blood glucose to the A~2DS~2 score,we called it the modified A~2DS~2 score(m A~2DS~2 score).The higher the A~2DS~2 score and the m A~2DS~2 score,the higher the incidence of SAP.The AUC and 95%CI of the A~2DS~2 score and the m A~2DS~2 score were 0.793(0.777,0.809)and 0.814(0.798,0.828).And the AUC of the m A~2DS~2 score was higher than the A~2DS~2 score(Z=2.704,P<0.05),with statistically significant difference.The best cut-off value of the A~2DS~2 score was 3,sensitivity and specificity was 81.5% and 62.2%.And the optimum cutoff point was 4 of the m A~2DS~2 score,sensitivity and specificity was 83.5% and 64.9%.Conclusion:1.Fasting hyperglycemia is an independent risk factor of acute ischemic stroke associated pneumonia.2.Both the A~2DS~2 score and the m A~2DS~2 score might be simple and effective predictive tools for SAP in patients with acute ischemic stroke in this study.The predictive value for SAP of the m A~2DS~2 score might be superior to the A~2DS~2 score in this study.