Reduced Vitamin D Levels are Associated with Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke

Abstract

Background and aim

Stroke-associated pneumonia (SAP) is a common complication in patients with acute ischemic stroke (AIS). This study explored the potential relationship between serum vitamin D levels and SAP.

Methods

This study recruited 863 consecutive AIS patients. In-hospital SAP was defined as a complication that occurred after stroke, during hospitalization, that was confirmed radiographically. Serum vitamin D levels were measured within 24 hrs of admission and the patients were divided into vitamin D sufficient (>50 nmol/L), insufficient (25–50 nmol/L), and deficient (<25 nmol/L) groups.

Results

In this study, 102 (11.8%) patients were diagnosed with SAP. Compared to the patients without SAP, patients with SAP had significantly lower vitamin D levels (P = 0.023). The incidence of SAP was significantly higher in patients with vitamin D deficiency than in those with vitamin D insufficiency or sufficiency (21.2% vs 16.2% & 9.5%, P = 0.006). After adjusting for confounders, vitamin D deficiency and insufficiency were independently associated with SAP (OR = 3.034, 95% CI = 1.207–7.625, P = 0.018; OR = 1.921, 95% CI = 1.204–3.066, P = 0.006, respectively). In multiple-adjusted spline regression, vitamin D levels showed a linear association with the risk of SAP (P < 0.001 for linearity).

Conclusion

Reduced vitamin D is a potential risk factor of in-hospital SAP, which can help clinicians identify high-risk SAP patients.

Keywords:

• acute ischemic stroke
• stroke-associated pneumonia
• vitamin D

Acknowledgments

We thank the study participants and the clinical staff at all participating hospitals for their support and contribution to this project.

Abbreviations

AIS, acute ischemic stroke; BUN, blood urea nitrogen; CI, confidence interval; COPD, Chronic obstructive pulmonary disease; DBP, diastolic blood pressure; GFR, glomerular filtration rate; 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.

Data Sharing Statement

The data supporting this study is available from the corresponding author for reasonable request.

Disclosure

The authors declare that there are no conflicts of interest in this work.