Risk factors for lung infection in stroke patients: a meta-analysis of observational studies

Abstract

Background: The aims of this meta-analysis were to evaluate the risk factors associated with lung infections in stroke patients and to provide evidence for prevention decisions. Methods: We searched the Embase, PubMed, EBSCO and Web of Science databases to collect studies from January 2000 to July 2015. Results: The meta-analysis identified 23 risk factors for lung infections in stroke patients, and the top 5, ranked by order according to odds ratio values (95% confidence interval), were as follows: multiple vertebrobasilar stroke, 22.99 (4.04, 130.83); National Institutes of Health Stroke Scale score >15 points, 14.63 (8.54, 25.08); mechanical ventilation, 10.20 (7.15, 14.57); nasogastric tube use, 9.87 (6.21, 15.70); and dysphagia, 7.50 (2.60, 21.65). Conclusion: Preventive measures should be taken against these risk factors to reduce the incidence of lung infection.

Keywords:

• lung infection
• pneumonia
• risk factors
• meta-analysis
• stroke
• stroke-associated pneumonia

Financial & competing interests disclosure

This work was supported by the National Clinical Key Specialty Construction Foundation of China [2010(305)], the National Clinical Key Specialty Construction Foundation of China [2012(649)] and the Traditional Chinese Medicine Department of Chongqing Health Bureau [2012-1-9]. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Lung infections in stroke patients often lead to poor prognoses.

• Post-stroke pneumonia is associated with old age, history of diseases, neurological impairment and severity of illness, the use of invasive operations and drug treatment, and the scope and area of the stroke.

• Old age is an independent risk factor for post-stroke pneumonia.

• Among all common diseases, stroke patients with atrial fibrillation have the highest risk for lung infections, with an odds ratio (OR) value of 2.47.

• Patients with a National Institutes of Health Stroke Scale score >15 points have a 14.63-fold increased risk of pulmonary infection, compared with patients whose National Institutes of Health Stroke Scale scores are <15 points.

• The risk associated with the use of a ventilator ranks first among all invasive operations, with an OR value of 10.2.

• Dysphagia is one of the most common complications in stroke patients and is also a significant risk factor for lung infections in stroke patients.

• Among all other risk factors, multiple vertebrobasilar infarction-related stroke has the highest risk for lung infections, with an OR value of 22.99.

Notes