The Predictive Value Of Neutrophil-to-Lymphocyte Ratio Combined With Fibrinogen-to-Albumin Ratio For Stroke-Associated Pneumonia

Objective:Stroke-associated pneumonia(SAP)is a common complication of stroke,which is related to the poor prognosis of acute ischemic stroke(AIS).Inflammation plays an important role in the development of SAP.The aim of this study was to analyze the risk factors for SAP in patients with AIS,to explore the predictive value of Neutrophilto-Lymphocyte ratio(NLR)combined with Fibrinogen-to-Albumin ratio(FAR)for SAP.Methods:A retrospective study was conducted to collect AIS patients admitted to Southern Medical University Zhujiang Hospital from January 2018 to December 2021.All AIS patients were collected via Stroke Channel.There were 272 AIS patients who met the inclusion criteria.Patients were divided into SAP Group and non-SAP group according to whether SAP occurred within one week after admission.Then we collected their data,including baseline data(age,sex,hypertension,diabetes,coronary heart disease,atrial fibrillation,history of stroke,intravenous thrombolytic therapy,TOAST etiologic classification,infarct site,length of hospital stay and gastric tube indwelling)、imaging data(cranial CT,cranial magnetic resonance imagine)and first blood test after stroke in our hospital(neutrophil,lymphocyte,fibrinogen,albumin,NLR,FAR).Univariate analysis was used to analyze the difference between SAP Group and non-SAP Group.Multivariate Logistic regression analysis was used to find out the independent risk factors of SAP.ROC curves were drawn to evaluate the predictive value of NLR,FAR and NLR combined with FAR for SAP.Results:1.A total of 272 patients with ischemic stroke who met the study criteria were included in this study,78(28.7%)in the SAP Group and 194(71.3%)in the non-SAP group.2.Univariate analysis showed significant differences in age,sex,length of hospital stay,gastric tube indwelling,TOAST classification,infarct site,neutrophil,lymphocyte,fibrinogen,albumin,NLR,and FAR between the two groups(P<0.05);There were no significant differences between the two groups in hypertension,diabetes,coronary heart disease,atrial fibrillation,stroke history and intravenous thrombolytic therapy(P<0.05).3.Multivariate Logistic regression analysis showed that age ≥65 years,gastric tube indwelling,NIHSS score ≥15,posterior circulation ischemia,NLR,FAR were independent risk factors of SAP in stroke patients(P<0.05).4.The AUC of NLR for predicting SAP was 0.725,with a sensitivity of 61.5%and a specificity of 75.8%,and the AUC of FAR for predicting SAP was 0.792,with a sensitivity of 75.6%and a specificity of 74.2%,the AUC of SAP was 0.855,with a sensitivity of 76.9%and a specificity of 83.0%.The AUC of NLR combined with FAR in predicting SAP was higher than that of single index.Conclusion:Age ≥ 65 years,indwelling gastric tube,NIHSS score ≥15,posterior circulation infarction,NLR,FAR were independent risk factors for SAP.NLR combined with FAR has good predictive value for SAP,which is helpful to identify the patients with high risk of SAP in early stage,and to carry out early clinical intervention and treatment so as to reduce the occurrence of SAP.