Journal of the Korean neurological association (대한신경과학회지)

Korean Neurological Association (대한신경과학회)
권호 표지

Predicting Factors in the Development of Pneumonia after Acute Stroke

급성 뇌졸중 후 발생하는 폐렴에 관한 예측인자

Kwon, Hyung-Min;Jeong, Sang-Wuk;Hong, Keun-Sik;Han, Mun-Gu;Chu, Kon;Yoon, Byung-Woo
권형민;정상욱;홍근식;한문구;주건;윤병우

  • Published : 20031000
⟨ Previous Next ⟩

Abstract

Background : Pneumonia is a common medical complication after acute stroke, and makes a considerable influence on the prognosis. It is potentially preventable or treatable if early recognized. Thus, the identification of which patients are at risk for the development of pneumonia is clinically significant. Methods : A total of 240 patients with an acute stroke who were consecutively admitted to a Seoul National University Hospital were studied. The following prognostic factors were accounted for in the statistical analyses : age, sex, hypertension, diabetes, cardiac disease, smoking, recurrent stroke, NIHSS, modified Rankin scale (mRS), the presence of dysphagia, blood pressure, body temperature, white blood cell count, blood sugar, fibrinogen, Levin tube insertion, Foley catheter insertion, and subtype of stroke. Results : Pneumonia was diagnosed in 36 (17.0%) patients during the acute stage of stroke, particularly within 2 weeks. Average admission stay of patients with pneumonia was 38.7 days, whereas it was 19.3 days for those without pneumonia. By multivariate analysis, Levin tube insertion, body temperature, recurrent stroke, and mRS were significant predictor of pneumonia development. Forty percent of patients with four or five points of mRS developed pneumonia, compared to 6% in less than four points. Conclusions : Our results show that the patients who have Levin tube, high mRS, or recurrent stroke tend to develop pneumonia after acute stroke. It is important for early detection and prevention of pneumonia in patients with high mRS.

Keywords

References

  1. Roth EJ. Medical complications encountered in stroke rehabilitation. Phys Med Rehab Clin North Am 1991;2:563-578.
  2. Katzan IL, Cebul RD, Husak SH, Dawson NV, Baker DW. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology 2003;60:620-625. https://doi.org/10.1212/01.WNL.0000046586.38284.60
  3. Garon B, Engle M, Armiston. Silent aspiration: results of 1,000 videofluoroscopic swallow evaluations. J Neurol Rehab 1996;10:121-126.
  4. Dobkin BH. Neuromedical complications in stroke patients transferred for rehabilitation before and after diagnostic related groups. J Neurol Rehabil 1987;1:3-7.
  5. Dromerick A, Reding M. Medical and neurological complications during inpatient stroke rehabilitation. Stroke 1994;25:358-361. https://doi.org/10.1161/01.STR.25.2.358
  6. Kalra L, Yu G, Wilson K, Roots P. Medical complications during stroke rehabilitation. Stroke 1995;26:990-994. https://doi.org/10.1161/01.STR.26.6.990
  7. Davenport RJ, Dennis MS, Wellwood I, Warlow C. Complications after acute stroke. Stroke 1996;27:415-420. https://doi.org/10.1161/01.STR.27.3.415
  8. Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C, et al. Medical complication after stroke: a multicenter study. Stroke 2000;31:1223-1229. https://doi.org/10.1161/01.STR.31.6.1223
  9. Minn YK, Heo JH, Kim KW, Choi IS. The prognostic significance of infection in acute stroke. a preliminary report. J Korean Neurol Assoc 1996;14(2):382-388.
  10. Addington WR, Stephens RE, Gilliland KA. Assessing the laryngeal cough reflex and the risk of developing pneumonia after stroke: an interhospital comparison. Stroke 1999;30:1203-1207. https://doi.org/10.1161/01.STR.30.6.1203
  11. Marik PE. Primary care: Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344:665-671. https://doi.org/10.1056/NEJM200103013440908
  12. Hanson S, Degraba TJ, Villar-Cordova C, Yatsu FM. Medical complication of stroke. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM. Stroke: pathophysiology, diagnosis, and management. 3rd ed. Vol. 2. Philadelphia: Churchill Livingstone. 1998;1121-1129.
  13. Pinto AN, Melo TP, Lourenco ME, Leandro MJ, Brazio A, Carvalho L, et al. Can a clinical classification of stroke predict complications and treatment during hospitalization? Cerebrovasc Dis 1998;8:204-209.
  14. Alberts MJ, Horner J, Gray L, Brazer SR. Aspiration after stroke: lesion analysis by brain MRI. Dysphagia 1992;7:170-173. https://doi.org/10.1007/BF02493452
  15. Stroke-1989. Recommendations on stroke prevention, diagnosis, and therapy: report of the WHO Task Force on Stroke and Other Cerebrovascular Disorders. Stroke 1989;20:1407-1431. https://doi.org/10.1161/01.STR.20.10.1407
  16. Biller J, Love BB, Marsh EE III, Jones MP, Knepper LE, Jiang D, et al. Spontaneous improvement after acute ischemic stroke. A pilot study. Stroke 1990;21:1008-1012. https://doi.org/10.1161/01.STR.21.7.1008
  17. Sulter G, Steen C, De Keyser J. Use of the Barthel Index and modified Rankin Scale in acute stroke trials. Stroke 1999;30:1538-1541. https://doi.org/10.1161/01.STR.30.8.1538
  18. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521-1526. https://doi.org/10.1016/0140-6736(91)93206-O
  19. Lindley RI, Warlow CP, Wardlaw JM, Dennis MS, Slattery J, Sandercock PA. Interobserver reliability of a clinical classification of acute cerebral infarction. Stroke 1993;24:1801-1804. https://doi.org/10.1161/01.STR.24.12.1801
  20. Roberts L, Counsell C. Assessment of clinical outcomes in acute stroke trials. Stroke 1998;29:986-991. https://doi.org/10.1161/01.STR.29.5.986
  21. D’Olhaberriague L, Litvan I, Mitsias P, Mansbach HH. A reappraisal of reliability and validity studies in stroke. Stroke 1996;27:2331-2336. https://doi.org/10.1161/01.STR.27.12.2331
  22. Cassiere HA, Niederman MS. Aspiration pneumonia, lipoid pneumonia, and lung abscess. In: Baum GL, Crapo JD, Celli BR, Karlinsky JB. Textbook of pulmonary diseases. 6th ed. Vol. 1. Philadelphia: Lippincott-Raven 1998:645-655.
  23. Huxley EJ, Viroslav J, Gray WR, Pierce AK. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med 1978;64:564-568. https://doi.org/10.1016/0002-9343(78)90574-0
  24. Gleeson K, Eggli DF, Maxwell SL. Quantitative aspiration during sleep in normal subjects. Chest 1997;111:1266-1272. https://doi.org/10.1378/chest.111.5.1266
  25. Diagnosis and treatment of swallowing disorders (dysphagia) in acute care stroke: summary, evidence report/technology assessment. No. 8. Rockville, Md.: Agency for Health Care Policy and Research, March 1999. (See http://www.ahcpr.gov/clinic/dysphsum.htm.)
  26. Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol 1994;51:1051-1053. https://doi.org/10.1001/archneur.1994.00540220099020
  27. Kidd D, Lawson J, Nesbitt R, MacMahon J. Aspiration in acute stroke: a clinical study with videofluoroscopy. Q J Med 1993;86:825-829.
  28. Smithard DG, O’Neill PA, England RE, Park CL, Wyatt R, Martin DF, et al. The natural history of dysphagia following a stroke. Dysphagia 1997;12:188-193. https://doi.org/10.1007/PL00009535
  29. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999;30:744-748. https://doi.org/10.1161/01.STR.30.4.744
  30. Horner J, Massey EW. Silent aspiration following stroke. Neurology 1988;38:317-319. https://doi.org/10.1212/WNL.38.2.317
  31. de Larminat V, Montravers P, Dureuil B, Desmonts JM. Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med 1995;23:486-490. https://doi.org/10.1097/00003246-199503000-00012
  32. Tolep K, Getch CL, Criner GJ. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest 1996;109:167-172. https://doi.org/10.1378/chest.109.1.167
  33. Leder SB, Cohn SM, Moller BA. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia 1998;13:208-212. https://doi.org/10.1007/PL00009573
  34. Mostafa G, Huynh T, Sing RF, Miles WS, Norton HJ, Thomason MH. Gender-related outcomes in trauma. J Trauma 2002;53:430-435. https://doi.org/10.1097/00005373-200209000-00006
  35. Offner PJ, Moore EE, Biffl WL. Male gender is a risk factor for major infections after surgery. Arch Surg 1999;134:935-940. https://doi.org/10.1001/archsurg.134.9.935
  36. Zellweger R, Wichmann MW, Ayala A, Stein S, DeMaso CM, Chaudry IH. Females in proestrus state maintain splenic immune functions and tolerate sepsis better than males. Crit Care Med 1997;25:106-110. https://doi.org/10.1097/00003246-199701000-00021
  37. Wichmann MW, Zellweger R, DeMaso CM, Ayala A, Chaudry IH. Mechanism of immunosuppression in males following trauma-hemorrhage. Critical role of testosterone. Arch Surg 1996;131:1186-1192. https://doi.org/10.1001/archsurg.1996.01430230068012
  38. Angele MK, Ayala A, Monfils BA, Cioffi WG, Bland KI, Chaudry IH. Testosterone and/or low estradiol: normally required but harmful immunologically for males after trauma-hemorrhage. J Trauma 1998;44:78-85. https://doi.org/10.1097/00005373-199801000-00007
  39. Remmers DE, Cioffi WG, Bland KI, Wang P, Angele MK, Chaudry IH. Testosterone: the crucial hormone responsible for depressing myocardial function in males after trauma-hemorrhage. Ann Surg 1998;227:790-799. https://doi.org/10.1097/00000658-199806000-00002
  40. Angele MK, Ayala A, Cioffi WG, Bland KI, Chaudry IH. Testosterone: the culprit for producing splenocyte immune depression after trauma-hemorrhage. Am J Physiol 1998;274:1530-1536. https://doi.org/10.1152/ajpcell.1998.274.6.C1530