Predictors of mortality and disability in stroke-associated pneumonia

Rory J. Tinker (Corresponding Author), Craig J. Smith, Calvin Heal, Joao H. Bettencourt-Silva, Anthony K. Metcalf, John F. Potter, Phyo K. Myint (Corresponding Author)

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Whilst stroke-associated pneumonia (SAP) is common and associated with poor outcomes, less is known about the determinants of these adverse clinical outcomes in SAP. To identify the factors that influence mortality and morbidity in SAP. Data for patients with SAP (n = 854) were extracted from a regional Hospital Stroke Register in Norfolk, UK (2003–2015). SAP was defined as pneumonia occurring within 7 days of admission by the treating clinicians. Mutlivariable regression models were constructed to assess factors influencing survival and the level of disability at discharge using modified Rankin Scale [mRS]. Mean (SD) age was 83.0 (8.7) years and ischaemic stroke occurred in 727 (85.0%). Mortality was 19.0% at 30 days and 44.0% at 6 months. Stroke severity assessment using National Institutes of Health Stroke Scale was not recorded in the data set although Oxfordshire Community Stroke Project was Classification. In the multivariable analyses, 30-day mortality was independently associated with age (OR 1.04, 95% CI 1.01–1.07, p = 0.01), haemorrhagic stroke (2.27, 1.07–4.78, p = 0.03) and pre-stroke disability (mRS 4–5 v 0–1: 6.45, 3.12–13.35, p < 0.001). 6-month mortality was independently associated with age (< 0.001), pre-stroke disability (p < 0.001) and certain comorbidities, including the following: dementia (6.53, 4.73–9.03, p < 0.001), lung cancer (2.07, 1.14–3.77, p = 0.017) and previous transient ischemic attack (1.94, 1.12–3.36, p = 0.019). Disability defined by mRS at discharge was independently associated with age (1.10, 1.05–1.16, p < 0.001) and plasma C-reactive protein (1.02, 1.01–1.03, p = 0.012). We have identified non-modifiable determinants of poor prognosis in patients with SAP. Further studies are required to identify modifiable factors which may guide areas for intervention to improve the prognosis in SAP in these patients.
Original languageEnglish
Number of pages7
JournalActa Neurologica Belgica
Early online date29 Apr 2019
DOIs
Publication statusE-pub ahead of print - 29 Apr 2019

Fingerprint

Pneumonia
Stroke
Mortality
Transient Ischemic Attack
National Institutes of Health (U.S.)
C-Reactive Protein
Dementia
Comorbidity
Blood Proteins
Lung Neoplasms
Morbidity

Keywords

  • stroke
  • pneumonia
  • mortality
  • morbidity
  • stroke associated
  • Pneumonia
  • Stroke
  • Stroke associated
  • Mortailty
  • Morbidity

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Tinker, R. J., Smith, C. J., Heal, C., Bettencourt-Silva, J. H., Metcalf, A. K., Potter, J. F., & Myint, P. K. (2019). Predictors of mortality and disability in stroke-associated pneumonia. Acta Neurologica Belgica. https://doi.org/10.1007/s13760-019-01148-w

Predictors of mortality and disability in stroke-associated pneumonia. / Tinker, Rory J. (Corresponding Author); Smith, Craig J.; Heal, Calvin; Bettencourt-Silva, Joao H.; Metcalf, Anthony K.; Potter, John F.; Myint, Phyo K. (Corresponding Author).

In: Acta Neurologica Belgica, 29.04.2019.

Research output: Contribution to journalArticle

Tinker RJ, Smith CJ, Heal C, Bettencourt-Silva JH, Metcalf AK, Potter JF et al. Predictors of mortality and disability in stroke-associated pneumonia. Acta Neurologica Belgica. 2019 Apr 29. https://doi.org/10.1007/s13760-019-01148-w
Tinker, Rory J. ; Smith, Craig J. ; Heal, Calvin ; Bettencourt-Silva, Joao H. ; Metcalf, Anthony K. ; Potter, John F. ; Myint, Phyo K. / Predictors of mortality and disability in stroke-associated pneumonia. In: Acta Neurologica Belgica. 2019.
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abstract = "Whilst stroke-associated pneumonia (SAP) is common and associated with poor outcomes, less is known about the determinants of these adverse clinical outcomes in SAP. To identify the factors that influence mortality and morbidity in SAP. Data for patients with SAP (n = 854) were extracted from a regional Hospital Stroke Register in Norfolk, UK (2003–2015). SAP was defined as pneumonia occurring within 7 days of admission by the treating clinicians. Mutlivariable regression models were constructed to assess factors influencing survival and the level of disability at discharge using modified Rankin Scale [mRS]. Mean (SD) age was 83.0 (8.7) years and ischaemic stroke occurred in 727 (85.0{\%}). Mortality was 19.0{\%} at 30 days and 44.0{\%} at 6 months. Stroke severity assessment using National Institutes of Health Stroke Scale was not recorded in the data set although Oxfordshire Community Stroke Project was Classification. In the multivariable analyses, 30-day mortality was independently associated with age (OR 1.04, 95{\%} CI 1.01–1.07, p = 0.01), haemorrhagic stroke (2.27, 1.07–4.78, p = 0.03) and pre-stroke disability (mRS 4–5 v 0–1: 6.45, 3.12–13.35, p < 0.001). 6-month mortality was independently associated with age (< 0.001), pre-stroke disability (p < 0.001) and certain comorbidities, including the following: dementia (6.53, 4.73–9.03, p < 0.001), lung cancer (2.07, 1.14–3.77, p = 0.017) and previous transient ischemic attack (1.94, 1.12–3.36, p = 0.019). Disability defined by mRS at discharge was independently associated with age (1.10, 1.05–1.16, p < 0.001) and plasma C-reactive protein (1.02, 1.01–1.03, p = 0.012). We have identified non-modifiable determinants of poor prognosis in patients with SAP. Further studies are required to identify modifiable factors which may guide areas for intervention to improve the prognosis in SAP in these patients.",
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AU - Potter, John F.

AU - Myint, Phyo K.

N1 - We thank the data team of the Norfolk and Norwich University Hospital Stroke Services. We also thank Prof Bowles (one of the co-PIs of the stroke register) and our lay steering committee members and independent chair Prof Forbes (Chief of Research & Innovation, Norfolk and Norwich University Hospital).

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N2 - Whilst stroke-associated pneumonia (SAP) is common and associated with poor outcomes, less is known about the determinants of these adverse clinical outcomes in SAP. To identify the factors that influence mortality and morbidity in SAP. Data for patients with SAP (n = 854) were extracted from a regional Hospital Stroke Register in Norfolk, UK (2003–2015). SAP was defined as pneumonia occurring within 7 days of admission by the treating clinicians. Mutlivariable regression models were constructed to assess factors influencing survival and the level of disability at discharge using modified Rankin Scale [mRS]. Mean (SD) age was 83.0 (8.7) years and ischaemic stroke occurred in 727 (85.0%). Mortality was 19.0% at 30 days and 44.0% at 6 months. Stroke severity assessment using National Institutes of Health Stroke Scale was not recorded in the data set although Oxfordshire Community Stroke Project was Classification. In the multivariable analyses, 30-day mortality was independently associated with age (OR 1.04, 95% CI 1.01–1.07, p = 0.01), haemorrhagic stroke (2.27, 1.07–4.78, p = 0.03) and pre-stroke disability (mRS 4–5 v 0–1: 6.45, 3.12–13.35, p < 0.001). 6-month mortality was independently associated with age (< 0.001), pre-stroke disability (p < 0.001) and certain comorbidities, including the following: dementia (6.53, 4.73–9.03, p < 0.001), lung cancer (2.07, 1.14–3.77, p = 0.017) and previous transient ischemic attack (1.94, 1.12–3.36, p = 0.019). Disability defined by mRS at discharge was independently associated with age (1.10, 1.05–1.16, p < 0.001) and plasma C-reactive protein (1.02, 1.01–1.03, p = 0.012). We have identified non-modifiable determinants of poor prognosis in patients with SAP. Further studies are required to identify modifiable factors which may guide areas for intervention to improve the prognosis in SAP in these patients.

AB - Whilst stroke-associated pneumonia (SAP) is common and associated with poor outcomes, less is known about the determinants of these adverse clinical outcomes in SAP. To identify the factors that influence mortality and morbidity in SAP. Data for patients with SAP (n = 854) were extracted from a regional Hospital Stroke Register in Norfolk, UK (2003–2015). SAP was defined as pneumonia occurring within 7 days of admission by the treating clinicians. Mutlivariable regression models were constructed to assess factors influencing survival and the level of disability at discharge using modified Rankin Scale [mRS]. Mean (SD) age was 83.0 (8.7) years and ischaemic stroke occurred in 727 (85.0%). Mortality was 19.0% at 30 days and 44.0% at 6 months. Stroke severity assessment using National Institutes of Health Stroke Scale was not recorded in the data set although Oxfordshire Community Stroke Project was Classification. In the multivariable analyses, 30-day mortality was independently associated with age (OR 1.04, 95% CI 1.01–1.07, p = 0.01), haemorrhagic stroke (2.27, 1.07–4.78, p = 0.03) and pre-stroke disability (mRS 4–5 v 0–1: 6.45, 3.12–13.35, p < 0.001). 6-month mortality was independently associated with age (< 0.001), pre-stroke disability (p < 0.001) and certain comorbidities, including the following: dementia (6.53, 4.73–9.03, p < 0.001), lung cancer (2.07, 1.14–3.77, p = 0.017) and previous transient ischemic attack (1.94, 1.12–3.36, p = 0.019). Disability defined by mRS at discharge was independently associated with age (1.10, 1.05–1.16, p < 0.001) and plasma C-reactive protein (1.02, 1.01–1.03, p = 0.012). We have identified non-modifiable determinants of poor prognosis in patients with SAP. Further studies are required to identify modifiable factors which may guide areas for intervention to improve the prognosis in SAP in these patients.

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KW - Stroke associated

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