轻中度急性缺血性脑卒中并发卒中相关性肺炎的危险因素分析

doi:10.3969/j.issn.1006-9771.2023.06.012

Abstract

Abstract:

Objective To explore the risk factors of stroke-associated pneumonia (SAP) for patients with mild to moderate acute ischemic stroke (AIS).
Methods From October, 2016 to December, 2019, 321 patients with mild to moderate AIS in Beijing Bo'ai Hospital were collected and divided into SAP group (n = 71) and non-SAP group (n = 250) according to whether they were complicated with SAP. Gender, age, time from symptom onset to admission, systolic pressure, diastolic pressure, scores of National Institutes of Health Stroke Scale (NIHSS) at admission, and medical history were recorded. Laboratory indexes including the count of white blood cell and platelet, levels of D-dimer, hypersensitive C-reactive protein (hs-CRP) and α-hydroxybutyrate dehydrogenase (α-HBDH) were measured.
Results Univariate analysis showed that age, NIHSS score, history of hypertension, atrial fibrillation, prior cerebral infarction, the count of white blood cell and platelet, the levels of D-dimer, hs-CRP and α-HBDH were the influencing factors of SAP (P < 0.2). Multivariate Logistic regression showed that age > 70 years old (OR = 7.121, 95%CI 3.493 to 14.514, P < 0.001), NIHSS score > 4 (5 to 10, OR = 4.861, 95% CI 2.412 to 9.797, P < 0.001), the count of platelet > 300×10⁹/L (OR = 6.978, 95% CI 1.864 to 26.128, P = 0.004), and the level of D-dimer > 1.0 mg/L (OR = 3.036, 95% CI, 1.518 to 6.071, P = 0.002) were the risk factors of SAP. The model fitted the original data well (HL = 1.509，P = 0.680) and appeared a good prediction (AUC = 0.847, 95% CI 0.796 to 0.898, P < 0.001).
Conclusion Age > 70 years old, NIHSS score > 4 (5 to 10), the count of platelet > 300×10⁹/L and the level of D-dimer > 1.0 mg/L were the risk factors of SAP for patients with mild to moderate AIS.

Key words: acute ischemic stroke, stroke-associated pneumonia, risk factors

CLC Number:

R743.3

DENG Ting, CHEN Jingmian, LIU Xiaomeng, YAO Xiaohua, LIU Lushan, HE Wei, ZHANG Tong, LU Haitao. Risk factors of stroke-associated pneumonia for patients with mild to moderate acute ischemic stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 708-713.

Figures/Tables 5

References 39

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项目	SAP组(n = 71)	非SAP组(n = 250)	t/χ²/Z值	P值
性别(男/女)/n	41/30	194/56	0.586	0.444
年龄/岁	79.51±9.92	66.38±10.93	1.109	< 0.001
发病时间/h	10.00 (3.00, 27.00)	13.50 (5.00, 33.00)	-1.131	0.258
收缩压/mmHg	155.00 (140.00, 172.00)	154.0 (139.75, 172.00)	-0.036	0.971
舒张压/mmHg	89.00 (78.00, 102.50)	90.00 (80.00, 103,00)	-1.124	0.259
NIHSS评分	4.00 (2.00, 7.00)	3.00 (2.00, 4.00)	-4.379	< 0.001
既往病史/n
高血压	64	207	2.266	0.132
糖尿病	40	125	0.889	0.346
高脂血症	62	224	0.295	0.587
心房纤颤	14	29	3.141	0.076
脑梗死	38	95	5.490	0.019
抗血小板治疗	15	60	0.255	0.614
白细胞/(10⁹·L^-1)	6.88 (5.49, 8.88)	6.55 (5.40, 8.09)	-1.608	0.108
血小板/(10⁹·L^-1)	223.00(183.00, 265.00)	203.50 (174.00, 232.00)	-1.536	0.125
D-二聚体/(mg·L^-1)	1.08 (0.36, 2.35)	0.33 (0.19, 0.75)	-6.403	< 0.001
hs-CRP/(mg·dL^-1)	0.57 (0.19, 2.18)	0.26 (0.10, 0.49)	-4.173	< 0.001
α-HBDH/(U·L^-1)	164.00 (138.00, 212.00)	140.50 (122,00, 167.00)	-4.426	< 0.001

项目	回归系数	标准误	Wald	P值	OR值	95%CI
年龄(> 70岁)	1.963	0.363	29.189	< 0.001	7.121	3.493~14.514
NIHSS(> 4分)	1.581	0.358	19.554	< 0.001	4.861	2.412~9.797
血小板(> 300×10⁹/L)	1.943	0.674	8.319	0.004	6.978	1.864~26.128
D-二聚体(> 1.0 mg/L)	1.110	0.354	9.858	0.002	3.036	1.518~6.071
常量	-3.306	0.342	93.617	< 0.001	0.037

回归模型系数的综合检验			拟合优度检验
χ²值	自由度	P值	HL	自由度	P值
8.189	1	0.004	1.509	3	0.680
99.974	4	< 0.001
99.974	4	< 0.001

Risk factors of stroke-associated pneumonia for patients with mild to moderate acute ischemic stroke

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