Association between cumulative changes in the Wells score and the risk of stroke-associated pneumonia in patients with acute ischemic stroke: results from the REMISE study

Don't you know associations DO NOTHING FOR SURVIVOR RECOVERY!

You don't belong in stroke if you are doing predictions rather that delivering EXACT PROTOCOLS FOR RECOVERY!  

Didn't your competent? doctor already have protocols to prevent pneumonia? NO? So COMPLETELY FUCKING INCOMPETENT THEN?

For pneumonia maybe you want the vaccine if your doctor is competent enough to know about it.

You've known about this problem for a long time. SOLVE IT! 

Just maybe this vaccine!

Pneumonia Vaccine (3 posts to July 2020)

• 11% Stroke-associated pneumonia (17 posts to October 2020)

 Association between cumulative changes in the Wells score and the risk of stroke-associated pneumonia in patients with acute ischemic stroke: results from the REMISE study

Jing Yu^1†Dongze Li^1*†Jin Chen²Yi Liu¹Wei Zhang¹Yan Zhong³Yan Ma⁴Zhi Zeng¹Qinqin Wu⁵Zhi Wan^1*

• ¹Department of Emergency Medicine, Rare Diseases Center, National Clinical Research Center for Geriatrics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
• ²College of Arts, Sichuan University, Chengdu, China
• ³Department of Cadre Health Care, National Clinical Research Center for Geriatrics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
• ⁴School of Public Health, Xinjiang Medical University, Urumqi, China
• ⁵Health Management Center, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China

Introduction: The Wells score, a reliable indicator of thrombotic burden, has been associated with stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS). However, the impact of changes in dynamic Wells scores on the incidence and severity of SAP remains poorly understood.

Methods: A total of 767 participants with AIS were recruited from the Retrospective Multicenter Study for Ischemic Stroke Evaluation. Two Wells score measurements (i.e., at baseline and within the first 3 days) were obtained. Changes in dynamic Wells scores were then estimated using two indices: the cumulative Wells score and dynamic Wells score classes based on K-means analysis. The cumulative Wells score was calculated as the weighted sum of the mean Wells score value for each time interval (value × time). Dynamic Wells score classification was determined using K-means clustering analysis. Logistic regression was employed to analyze the effects of changes in dynamic Wells scores on the incidence of SAP.

Results: Among the included patients, 263 developed SAP. Four dynamic Wells score classes were identified. The incidence of SAP increased significantly with increasing cumulative Wells scores. After adjusting for confounders, an elevated cumulative Wells score was significantly associated with an increased incidence of SAP (p < 0.001). Compared with the class 1 group, the class 2, 3, and 4 groups had odds ratios for SAP incidence of 2.01 (p = 0.048), 3.71 (p = 0.001), and 9.90 (p < 0.001), respectively. Adding changes in dynamic Wells scores to a conventional risk model for SAP improved discrimination and calibration. Changes in dynamic Wells scores were positively correlated with the pneumonia severity index.

Discussion: Changes in dynamic Wells scores were independently associated with the incidence of SAP. Therefore, dynamic monitoring of changes in the Wells score may assist in the early identification of patients at high risk of developing SAP.

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