Predictive value of water swallow test score, serum albumin, and systemic immune-inflammation index for stroke-associated pneumonia in patients with acute isolated pontine infarction

 

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• 11% Stroke-associated pneumonia (18 posts to October 2020)

Predictive value of water swallow test score, serum albumin, and systemic immune-inflammation index for stroke-associated pneumonia in patients with acute isolated pontine infarction

• 

  Jingjing Ding 1†

• 

  Haifeng Jin 2†

• 

  Xiaomei Ren 1

• 

  Jieli Geng 2*

• 1. Department of Neurology, Yizheng People's Hospital, Yangzhou, China

• 2. Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Abstract

Objective: 

To identify independent predictors of stroke-associated pneumonia (SAP) in patients with acute isolated pontine infarction (AIPI) and to investigate the association between SAP and short-term prognosis.

Methods: 

This retrospective study included 179 consecutive patients with AIPI admitted between March 2021 and March 2024. Baseline clinical data, swallowing function, and serum biomarkers were analyzed. Independent predictors of SAP were determined using multivariate logistic regression, and predictive performance was assessed by receiver operating characteristic (ROC) curve analysis.

Results: 

SAP occurred in 19 (10.61%) patients. Compared with patients without SAP, those who developed SAP were older and had higher Water Swallow Test (WST) scores, National Institutes of Health Stroke Scale (NIHSS) scores, fibrinogen, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), as well as lower serum albumin levels (all p < 0.05). Multivariate logistic regression analysis identified WST score (OR = 2.622, 95% CI: 1.378–4.991, p = 0.003), serum albumin level (OR = 0.831, 95% CI: 0.735–0.940, p < 0.001), and SII (OR = 1.004, 95% CI: 1.002–1.006, p < 0.001) as independent predictors of SAP. The combined model incorporating these three variables demonstrated excellent predictive performance, with an area under the curve (AUC) of 0.938, sensitivity of 89.5%, and specificity of 86.9%. Furthermore, SAP was independently associated with short-term poor functional outcome [modified Rankin Scale (mRS) score ≥ 3] in patients with AIPI (OR = 8.082, 95% CI: 2.922–22.355, p < 0.001).

Conclusion: 

SAP is independently associated with a significantly increased risk of short-term poor functional outcome. WST score, serum albumin, and SII are independent predictors of SAP in patients with AIPI. Their combination provides a simple, cost-effective bedside model for early identification and prevention of post-stroke pneumonia.