Pneumonia and Risk of Serious Adverse Outcomes in Hospitalized Strokes in Thailand

Raphae S. Barlas, Allan B. Clark, Joao H. Bettencourt-Silva, Kittisak Sawanyawisuth, Kannikar Kongbunkiat, Narongrit Kasemsap, Somsak Tiamkao, Phyo Kyaw Myint (Corresponding Author)

Research output: Contribution to journalArticle

Abstract

Background: The impact of stroke associated pneumonia (SAP) on stroke complications is not well understood; we aimed to study the association between SAP and adverse outcomes including in-hospital mortality, prolonged length of stay and the risk of developing common serious complications (sepsis, respiratory failure, and convulsions). Methods: We retrospectively analyzed data from a cohort of 610,668 stroke patients drawn from the Universal Coverage Health Security Scheme (a national insurance database) in Thailand which covers ∼80% of the Thai population. Patients were hospitalized between October 2004 and January 2013. Results: Pneumonia was present in 9.6 % (n = 58,586) of patients. Aspiration pneumonia was present in 6.2% (n = 38,060) and nonaspiration pneumonia in 3.4% (n = 20,526). After adjusting for age, sex, stroke type, and comorbidities, patients with SAP had significantly higher odds of in-hospital mortality (odds ratio [OR] 2.90: 2.83-2.96), long length of stay (OR 13.11: 12.83-13.40), sepsis (OR 8.49: 8.22-8.76), respiratory failure (OR 4.37: 4.27-4.48), and convulsions (OR 2.09: 2.00-2.17). On subanalysis, patients with nonaspiration pneumonia were found to have higher odds of adverse outcomes compared to aspiration pneumonia; the corresponding ORs (95% confidence interval) for above outcomes were 1.25 (1.21-1.30), 2.40 (2.32-2.49), 1.34 (1.28-1.40), 1.80 (1.73-1.88), and 1.19 (1.11-1.28), respectively. Conclusions: SAP is associated with higher odds of inpatient mortality, long length of stay, and risk of developing serious stroke complications. Nonaspiration pneumonia is associated with significantly higher likelihood of adverse outcomes compared to aspiration pneumonia in this patient population. Early identification and treatment of SAP is vital in reducing adverse outcomes in acute stroke.
Original languageEnglish
Pages (from-to)1448-1454
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume28
Issue number6
Early online date4 Apr 2019
DOIs
Publication statusPublished - Jun 2019

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Thailand
Pneumonia
Stroke
Aspiration Pneumonia
Odds Ratio
Length of Stay
Hospital Mortality
Respiratory Insufficiency
Sepsis
Seizures
Universal Coverage
Insurance
Population
Comorbidity
Inpatients
Databases
Confidence Intervals
Mortality
Health

Keywords

  • Stroke
  • Stroke associated pneumonia
  • mortality
  • length of stay
  • complications
  • Mortality

Cite this

Pneumonia and Risk of Serious Adverse Outcomes in Hospitalized Strokes in Thailand. / Barlas, Raphae S.; Clark, Allan B.; Bettencourt-Silva, Joao H.; Sawanyawisuth, Kittisak ; Kongbunkiat, Kannikar; Kasemsap, Narongrit; Tiamkao, Somsak ; Myint, Phyo Kyaw (Corresponding Author).

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 28, No. 6, 06.2019, p. 1448-1454.

Research output: Contribution to journalArticle

Barlas, RS, Clark, AB, Bettencourt-Silva, JH, Sawanyawisuth, K, Kongbunkiat, K, Kasemsap, N, Tiamkao, S & Myint, PK 2019, 'Pneumonia and Risk of Serious Adverse Outcomes in Hospitalized Strokes in Thailand', Journal of Stroke and Cerebrovascular Diseases, vol. 28, no. 6, pp. 1448-1454. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.03.024
Barlas, Raphae S. ; Clark, Allan B. ; Bettencourt-Silva, Joao H. ; Sawanyawisuth, Kittisak ; Kongbunkiat, Kannikar ; Kasemsap, Narongrit ; Tiamkao, Somsak ; Myint, Phyo Kyaw. / Pneumonia and Risk of Serious Adverse Outcomes in Hospitalized Strokes in Thailand. In: Journal of Stroke and Cerebrovascular Diseases. 2019 ; Vol. 28, No. 6. pp. 1448-1454.
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abstract = "Background: The impact of stroke associated pneumonia (SAP) on stroke complications is not well understood; we aimed to study the association between SAP and adverse outcomes including in-hospital mortality, prolonged length of stay and the risk of developing common serious complications (sepsis, respiratory failure, and convulsions). Methods: We retrospectively analyzed data from a cohort of 610,668 stroke patients drawn from the Universal Coverage Health Security Scheme (a national insurance database) in Thailand which covers ∼80{\%} of the Thai population. Patients were hospitalized between October 2004 and January 2013. Results: Pneumonia was present in 9.6 {\%} (n = 58,586) of patients. Aspiration pneumonia was present in 6.2{\%} (n = 38,060) and nonaspiration pneumonia in 3.4{\%} (n = 20,526). After adjusting for age, sex, stroke type, and comorbidities, patients with SAP had significantly higher odds of in-hospital mortality (odds ratio [OR] 2.90: 2.83-2.96), long length of stay (OR 13.11: 12.83-13.40), sepsis (OR 8.49: 8.22-8.76), respiratory failure (OR 4.37: 4.27-4.48), and convulsions (OR 2.09: 2.00-2.17). On subanalysis, patients with nonaspiration pneumonia were found to have higher odds of adverse outcomes compared to aspiration pneumonia; the corresponding ORs (95{\%} confidence interval) for above outcomes were 1.25 (1.21-1.30), 2.40 (2.32-2.49), 1.34 (1.28-1.40), 1.80 (1.73-1.88), and 1.19 (1.11-1.28), respectively. Conclusions: SAP is associated with higher odds of inpatient mortality, long length of stay, and risk of developing serious stroke complications. Nonaspiration pneumonia is associated with significantly higher likelihood of adverse outcomes compared to aspiration pneumonia in this patient population. Early identification and treatment of SAP is vital in reducing adverse outcomes in acute stroke.",
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T1 - Pneumonia and Risk of Serious Adverse Outcomes in Hospitalized Strokes in Thailand

AU - Barlas, Raphae S.

AU - Clark, Allan B.

AU - Bettencourt-Silva, Joao H.

AU - Sawanyawisuth, Kittisak

AU - Kongbunkiat, Kannikar

AU - Kasemsap, Narongrit

AU - Tiamkao, Somsak

AU - Myint, Phyo Kyaw

PY - 2019/6

Y1 - 2019/6

N2 - Background: The impact of stroke associated pneumonia (SAP) on stroke complications is not well understood; we aimed to study the association between SAP and adverse outcomes including in-hospital mortality, prolonged length of stay and the risk of developing common serious complications (sepsis, respiratory failure, and convulsions). Methods: We retrospectively analyzed data from a cohort of 610,668 stroke patients drawn from the Universal Coverage Health Security Scheme (a national insurance database) in Thailand which covers ∼80% of the Thai population. Patients were hospitalized between October 2004 and January 2013. Results: Pneumonia was present in 9.6 % (n = 58,586) of patients. Aspiration pneumonia was present in 6.2% (n = 38,060) and nonaspiration pneumonia in 3.4% (n = 20,526). After adjusting for age, sex, stroke type, and comorbidities, patients with SAP had significantly higher odds of in-hospital mortality (odds ratio [OR] 2.90: 2.83-2.96), long length of stay (OR 13.11: 12.83-13.40), sepsis (OR 8.49: 8.22-8.76), respiratory failure (OR 4.37: 4.27-4.48), and convulsions (OR 2.09: 2.00-2.17). On subanalysis, patients with nonaspiration pneumonia were found to have higher odds of adverse outcomes compared to aspiration pneumonia; the corresponding ORs (95% confidence interval) for above outcomes were 1.25 (1.21-1.30), 2.40 (2.32-2.49), 1.34 (1.28-1.40), 1.80 (1.73-1.88), and 1.19 (1.11-1.28), respectively. Conclusions: SAP is associated with higher odds of inpatient mortality, long length of stay, and risk of developing serious stroke complications. Nonaspiration pneumonia is associated with significantly higher likelihood of adverse outcomes compared to aspiration pneumonia in this patient population. Early identification and treatment of SAP is vital in reducing adverse outcomes in acute stroke.

AB - Background: The impact of stroke associated pneumonia (SAP) on stroke complications is not well understood; we aimed to study the association between SAP and adverse outcomes including in-hospital mortality, prolonged length of stay and the risk of developing common serious complications (sepsis, respiratory failure, and convulsions). Methods: We retrospectively analyzed data from a cohort of 610,668 stroke patients drawn from the Universal Coverage Health Security Scheme (a national insurance database) in Thailand which covers ∼80% of the Thai population. Patients were hospitalized between October 2004 and January 2013. Results: Pneumonia was present in 9.6 % (n = 58,586) of patients. Aspiration pneumonia was present in 6.2% (n = 38,060) and nonaspiration pneumonia in 3.4% (n = 20,526). After adjusting for age, sex, stroke type, and comorbidities, patients with SAP had significantly higher odds of in-hospital mortality (odds ratio [OR] 2.90: 2.83-2.96), long length of stay (OR 13.11: 12.83-13.40), sepsis (OR 8.49: 8.22-8.76), respiratory failure (OR 4.37: 4.27-4.48), and convulsions (OR 2.09: 2.00-2.17). On subanalysis, patients with nonaspiration pneumonia were found to have higher odds of adverse outcomes compared to aspiration pneumonia; the corresponding ORs (95% confidence interval) for above outcomes were 1.25 (1.21-1.30), 2.40 (2.32-2.49), 1.34 (1.28-1.40), 1.80 (1.73-1.88), and 1.19 (1.11-1.28), respectively. Conclusions: SAP is associated with higher odds of inpatient mortality, long length of stay, and risk of developing serious stroke complications. Nonaspiration pneumonia is associated with significantly higher likelihood of adverse outcomes compared to aspiration pneumonia in this patient population. Early identification and treatment of SAP is vital in reducing adverse outcomes in acute stroke.

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KW - mortality

KW - length of stay

KW - complications

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