Predicting stroke-associated pneumonia for acute ischemic stroke patients post intravenous thrombolysis: the post-IVT-SAP risk score

Abstract

Introduction Few prediction tools have been developed specifically for stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT). This study aimed to develop and externally evaluate a simple risk score for SAP after IVT. Materials and methods This multicenter retrospective study included 836 patients with AIS treated with IVT at three hospitals. Patients from two hospitals formed the training cohort, and those from the third hospital formed the external validation cohort. Univariable and multivariable logistic regression analyses were performed to identify independent predictors and develop a simple risk prediction score. Model discrimination was evaluated using receiver operating characteristic curve analysis. Results Among 836 patients, 145 (17.3%) developed SAP. Age >75 years, atrial fibrillation, a higher pre-thrombolysis National Institutes of Health Stroke Scale score, and a lower pre-thrombolysis Alberta Stroke Program Early CT Score were independently associated with SAP and incorporated into the PISRS. The PISRS yielded an area under the curve of 0.718 in the training cohort and 0.801 (95% CI, 0.684–0.919) in the external validation cohort. Each 1-point increase in the PISRS was associated with increased odds of SAP within 7 days (OR = 2.623; 95% CI, 2.143–3.212). Conclusion The PISRS is a simple admission-based score that may facilitate early risk stratification for SAP in patients with AIS undergoing IVT. Further prospective validation in larger and more diverse cohorts is required.