Impact of stroke-associated pneumonia on mortality, length of hospitalization and functional outcome

Wen-Hui Teh, Craig J. Smith, Raphae S. Barlas, Adrian D. Wood, Joao H. Bettencourt-Silva, Allan B. Clark, Anthony K. Metcalf, Kristian M. Bowles, John F. Potter, Phyo K. Myint

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Abstract

Objectives
Stroke‐associated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce.

Materials and methods
This observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003‐April 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longer‐term mortality at predefined time periods (0‐90 days, 90 days‐1 year, 1‐3 years, and 3‐10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression.

Results
A total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7%) patients. The majority of these cases (n = 658; 60.8%) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95%CI [4.97‐6.93]), 0‐90 days (2.17 [1.97‐2.40]), and 91‐365 days (HR 1.31 [1.03‐1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67‐2.22]) and worse functional outcome (OR 7.17 [5.44‐9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year post‐stroke, but it was associated with reduced mortality beyond 3 years.

Conclusions
Stroke‐associated pneumonia is not associated with increased long‐term mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge.
Original languageEnglish
Pages (from-to)293-300
Number of pages8
JournalActa Neurologica Scandinavica
Volume138
Issue number4
Early online date10 May 2018
DOIs
Publication statusPublished - 1 Oct 2018

Fingerprint

Pneumonia
Hospitalization
Stroke
Mortality
Length of Stay
Logistic Models
Inpatients
Aspiration Pneumonia
Proportional Hazards Models
Tertiary Care Centers
England
Observational Studies
Comorbidity

Keywords

  • acute stroke
  • mortality
  • prognosis
  • stroke-associated pneumonia

Cite this

Teh, W-H., Smith, C. J., Barlas, R. S., Wood, A. D., Bettencourt-Silva, J. H., Clark, A. B., ... Myint, P. K. (2018). Impact of stroke-associated pneumonia on mortality, length of hospitalization and functional outcome. Acta Neurologica Scandinavica, 138(4), 293-300. https://doi.org/10.1111/ane.12956

Impact of stroke-associated pneumonia on mortality, length of hospitalization and functional outcome. / Teh, Wen-Hui; Smith, Craig J.; Barlas, Raphae S.; Wood, Adrian D.; Bettencourt-Silva, Joao H.; Clark, Allan B.; Metcalf, Anthony K.; Bowles, Kristian M.; Potter, John F.; Myint, Phyo K.

In: Acta Neurologica Scandinavica, Vol. 138, No. 4, 01.10.2018, p. 293-300.

Research output: Contribution to journalArticle

Teh, W-H, Smith, CJ, Barlas, RS, Wood, AD, Bettencourt-Silva, JH, Clark, AB, Metcalf, AK, Bowles, KM, Potter, JF & Myint, PK 2018, 'Impact of stroke-associated pneumonia on mortality, length of hospitalization and functional outcome', Acta Neurologica Scandinavica, vol. 138, no. 4, pp. 293-300. https://doi.org/10.1111/ane.12956
Teh W-H, Smith CJ, Barlas RS, Wood AD, Bettencourt-Silva JH, Clark AB et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization and functional outcome. Acta Neurologica Scandinavica. 2018 Oct 1;138(4):293-300. https://doi.org/10.1111/ane.12956
Teh, Wen-Hui ; Smith, Craig J. ; Barlas, Raphae S. ; Wood, Adrian D. ; Bettencourt-Silva, Joao H. ; Clark, Allan B. ; Metcalf, Anthony K. ; Bowles, Kristian M. ; Potter, John F. ; Myint, Phyo K. / Impact of stroke-associated pneumonia on mortality, length of hospitalization and functional outcome. In: Acta Neurologica Scandinavica. 2018 ; Vol. 138, No. 4. pp. 293-300.
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title = "Impact of stroke-associated pneumonia on mortality, length of hospitalization and functional outcome",
abstract = "ObjectivesStroke‐associated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce.Materials and methodsThis observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003‐April 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longer‐term mortality at predefined time periods (0‐90 days, 90 days‐1 year, 1‐3 years, and 3‐10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression.ResultsA total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7{\%}) patients. The majority of these cases (n = 658; 60.8{\%}) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95{\%}CI [4.97‐6.93]), 0‐90 days (2.17 [1.97‐2.40]), and 91‐365 days (HR 1.31 [1.03‐1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67‐2.22]) and worse functional outcome (OR 7.17 [5.44‐9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year post‐stroke, but it was associated with reduced mortality beyond 3 years.ConclusionsStroke‐associated pneumonia is not associated with increased long‐term mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge.",
keywords = "acute stroke, mortality, prognosis, stroke-associated pneumonia",
author = "Wen-Hui Teh and Smith, {Craig J.} and Barlas, {Raphae S.} and Wood, {Adrian D.} and Bettencourt-Silva, {Joao H.} and Clark, {Allan B.} and Metcalf, {Anthony K.} and Bowles, {Kristian M.} and Potter, {John F.} and Myint, {Phyo K.}",
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TY - JOUR

T1 - Impact of stroke-associated pneumonia on mortality, length of hospitalization and functional outcome

AU - Teh, Wen-Hui

AU - Smith, Craig J.

AU - Barlas, Raphae S.

AU - Wood, Adrian D.

AU - Bettencourt-Silva, Joao H.

AU - Clark, Allan B.

AU - Metcalf, Anthony K.

AU - Bowles, Kristian M.

AU - Potter, John F.

AU - Myint, Phyo K.

N1 - We thank the data team of the Norfolk and Norwich University Hospital Stroke Services.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - ObjectivesStroke‐associated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce.Materials and methodsThis observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003‐April 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longer‐term mortality at predefined time periods (0‐90 days, 90 days‐1 year, 1‐3 years, and 3‐10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression.ResultsA total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7%) patients. The majority of these cases (n = 658; 60.8%) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95%CI [4.97‐6.93]), 0‐90 days (2.17 [1.97‐2.40]), and 91‐365 days (HR 1.31 [1.03‐1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67‐2.22]) and worse functional outcome (OR 7.17 [5.44‐9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year post‐stroke, but it was associated with reduced mortality beyond 3 years.ConclusionsStroke‐associated pneumonia is not associated with increased long‐term mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge.

AB - ObjectivesStroke‐associated pneumonia (SAP) is common and associated with adverse outcomes. Data on its impact beyond 1 year are scarce.Materials and methodsThis observational study was conducted in a cohort of stroke patients admitted consecutively to a tertiary referral center in the east of England, UK (January 2003‐April 2015). Logistic regression models examined inpatient mortality and length of stay (LOS). Cox regression models examined longer‐term mortality at predefined time periods (0‐90 days, 90 days‐1 year, 1‐3 years, and 3‐10 years) for SAP. Effect of SAP on functional outcome at discharge was assessed using logistic regression.ResultsA total of 9238 patients (mean age [±SD] 77.61 ± 11.88 years) were included. SAP was diagnosed in 1083 (11.7%) patients. The majority of these cases (n = 658; 60.8%) were aspiration pneumonia. After controlling for age, sex, stroke type, Oxfordshire Community Stroke Project (OCSP) classification, prestroke modified Rankin scale, comorbidities, and acute illness markers, mortality estimates remained significant at 3 time periods: inpatient (OR 5.87, 95%CI [4.97‐6.93]), 0‐90 days (2.17 [1.97‐2.40]), and 91‐365 days (HR 1.31 [1.03‐1.67]). SAP was also associated with higher odds of long LOS (OR 1.93 [1.67‐2.22]) and worse functional outcome (OR 7.17 [5.44‐9.45]). In this cohort, SAP did not increase mortality risk beyond 1 year post‐stroke, but it was associated with reduced mortality beyond 3 years.ConclusionsStroke‐associated pneumonia is not associated with increased long‐term mortality, but it is linked with increased mortality up to 1 year, prolonged LOS, and poor functional outcome on discharge. Targeted intervention strategies are required to improve outcomes of SAP patients who survive to hospital discharge.

KW - acute stroke

KW - mortality

KW - prognosis

KW - stroke-associated pneumonia

U2 - 10.1111/ane.12956

DO - 10.1111/ane.12956

M3 - Article

VL - 138

SP - 293

EP - 300

JO - Acta Neurologica Scandinavica

JF - Acta Neurologica Scandinavica

SN - 0001-6314

IS - 4

ER -