https://orcid.org/0000-0003-3218-1312
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Abstract
Background
Stroke-associated pneumonia (SAP) is a serious and common complication in stroke patients.
Purpose
We aimed to develop and validate an easy-to-use model for predicting the risk of SAP in acute ischemic stroke (AIS) patients.
Patients and methods
The nomogram was established by univariate and multivariate binary logistic analyses in a training cohort of 643 AIS patients. The prediction performance was determined based on the receiver operating characteristic curve (ROC) and calibration plots in a validation cohort (N=340). Individualized clinical decision-making was conducted by weighing the net benefit in each AIS patient by decision curve analysis (DCA).
Results
Seven predictors, including age, NIHSS score on admission, atrial fibrillation, nasogastric tube intervention, mechanical ventilation, fibrinogen, and leukocyte count were incorporated to construct the nomogram model. The nomogram showed good predictive performance in ROC analysis [AUROC of 0.845 (95% CI: 0.814–0.872) in training cohort, and 0.897 (95% CI: 0.860–0.927) in validation cohort], and was superior to the A2DS2, ISAN, and PANTHERIS scores. Furthermore, the calibration plots showed good agreement between actual and nomogram-predicted SAP probabilities, in both training and validation cohorts. The DCA confirmed that the SAP nomogram was clinically useful.
Conclusion
Our nomogram may provide clinicians with a simple and reliable tool for predicting SAP based on routinely available data. It may also assist clinicians with respect to individualized treatment decision-making for patients differing in risk level.
Acknowledgments
We thank the study participants and the clinical staff at all participating hospitals for their support and contribution to this project. This work was supported by the Projects of Provincial Natural Science Foundation of Zhejiang (no. LY19H090013).
Abbreviations
AIS, acute ischemic stroke; AUROC, area under the receiver operating characteristic curve; CI, confidence interval; COPD, chronic obstructive pulmonary disease; DBP, diastolic blood pressure; GFR, glomerular filtration rate; Hcy, homocysteine; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; NIHSS, National Institutes of Health Stroke Scale; OR, odds ratio; SAP, stroke-associated pneumonia; SBP, systolic blood pressure; SCr, serum creatinine concentration; TIA, transient ischaemic attacks.
Data Sharing Statement
The data supporting this study are available from the corresponding author for reasonable request.
Author Contributions
Gui-Qian Huang and Zhen Wang conceived and designed this project; Yu-Ting Lin, Qian-Qian Cheng, Hao-Ran Cheng collected the data; Gui-Qian Huang, Yu-Ting Lin, and Yue-Min Wu conducted the data analysis; Gui-Qian Huang draft the paper. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.