Elevated platelet-to-lymphocyte ratio is associated with stroke-associated pneumonia in acute ischemic stroke: a retrospective cohort study

What fucking stupidity; predicting an association for pneumonia rather that creating a protocol to prevent it! You're all fired!

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)

Elevated platelet-to-lymphocyte ratio is associated with stroke-associated pneumonia in acute ischemic stroke: a retrospective cohort study

• 

  Tingting Duan ^1†

• C

  Chengfei Xu ¹

• J

  Jianmei Zhan ¹

• L

  Lanzhen Wang ¹

• 

  Zhaoping Wu ¹

• Y

  Yueqi Xu ²

• 

  Junnan Ye ²

• 

  Ming Yang ^{1† *}

• 1. Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China

• 2. Department of Emergency, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China

Abstract

Background: 

Stroke-associated pneumonia (SAP) is a common and serious complication of acute ischemic stroke (AIS) that substantially worsens clinical outcomes. The platelet-to-lymphocyte ratio (PLR), an accessible composite index derived from routine complete blood counts, may reflect post-stroke immune imbalance. However, its role in predicting SAP in AIS patients remains unexplored.

Methods: 

This retrospective cohort study included 1,745 patients with acute ischemic stroke (AIS) after systematic screening of 2,150 patients. After the original screening, 1,766 eligible patients remained; 21 additional patients with extreme PLR values (>1,000) were excluded. HbA1c missing values were imputed once using multiple imputation by chained equations (MICE) with a random forest estimator. PLR was calculated as platelet count divided by lymphocyte count and log2-transformed. Multivariable logistic regression, generalized additive modeling (GAM), and two-piecewise logistic regression were used to examine associations between PLR and stroke-associated pneumonia (SAP). Subgroup analyses were performed across seven clinical variables with interaction tested by likelihood ratio test. Predictive performance was evaluated by receiver operating characteristic (ROC) analysis and compared with C-reactive protein (CRP) and A2DS2 score using the DeLong test.

Results: 

SAP occurred in 359 patients (20.6%). PLR was higher in patients with SAP than in those without SAP (median 136.17 vs. 113.69, p < 0.001). In the fully adjusted model, log2-PLR remained associated with SAP (OR = 1.36 per 1-unit increase, 95% CI: 1.12–1.65, p = 0.0021). Compared with the lowest quartile, the highest PLR quartile was associated with increased SAP odds (OR = 1.62, 95% CI: 1.03–2.54, p = 0.0386). GAM and two-piecewise regression identified a threshold at PLR = 224.8 (log2-PLR = 7.812). Below this threshold, the association was not significant (OR = 1.21, 95% CI: 0.93–1.57, p = 0.1551), whereas above it the association was significant (OR = 2.06, 95% CI: 1.10–3.87, p = 0.0240). The AUCs were 0.584 for PLR, 0.825 for CRP, and 0.757 for A2DS2. The AUCs of the PLR + CRP and PLR + A2DS2 models were 0.803 and 0.763, respectively.

Conclusion: 

Elevated PLR is associated with SAP in AIS patients, exhibiting a non-linear threshold-dependent relationship. Although standalone discriminatory performance is modest, PLR is universally available from routine blood counts and may serve as a cost-effective tool for early SAP risk stratification. Prospective multicenter validation is warranted.

This seasonal habit promotes healthy aging and may reduce dementia risk in older people

 You competent? doctor has kept you up-to-date on all appropriate vaccines, right?

This seasonal habit promotes healthy aging and may reduce dementia risk in older people

Aging is inevitable, but there’s increasing evidence that it may be possible to prevent, or at least delay, age-related diseases, including cardiovascular disease and Alzheimer’s.

Although life expectancy has soared in the United States over the past century, many people are living longer in poorer health.

That’s why many aging experts are shifting the focus away from lifespan. Instead, the goal is to maximize our “healthspan,” aka the number of years spent living into older age in good health.

And slowing down biological aging often boils down to simple, healthy choices and preventive healthcare.

Dr. Ezekiel Emanuel, an oncologist and professor of medical ethics at the University of Pennsylvania, previously spoke to TODAY.com about evidence-based habits to promote longevity, including staying up to date on routine vaccinations.

There’s one vaccine in particular that’s especially important for adults over the age of 50, says Emanuel.

Longevity Tip of The Day: Stay Up To Date With Your Flu Vaccine to Promote Healthy Aging

If you’re an adult who wants to age healthier, get your annual flu shot, says Emanuel, who authored “Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life.”

The seasonal influenza vaccine is the most effective way to protect against severe illness, complications and death from flu.

In addition to these benefits, there’s growing evidence that the flu shot may protect against age-related neurodegenerative diseases.

“Cognitive decline is a serious worry, so (getting the flu shot) is one thing you can and should do,” says Emanuel.

Why It Matters

As we get older, our body’s natural immune defenses gradually weaken, making it harder to fight off infections. People over the age of 65 face a much higher risk of getting very sick, becoming hospitalized or dying from the flu.

“Thousands of people die every year from influenza,” says Emanuel.

There’s increasing evidence showing that routine adult vaccines like the flu shot are associated with a lower risk of Alzheimer’s in older adults, TODAY.com previously reported.

“Especially for people over 50, vaccines may reduce your risk of cognitive decline and dementia,” says Emanuel.

In a 2026 study published in Neurology, researchers found that the high-dose flu shot is associated with a 55% lower risk of Alzheimer’s in adults over 65 in the years following vaccination.

In addition to the flu shot, three other routine adult vaccines may cut dementia risk, says Ezekiel. These include the shingles vaccine, pneumococcal vaccine, and the diptheria, pertussis tetanus vaccine (Tdap).

So if you’re looking to protect your body and brain as you get older, staying up to date on these shots is crucial, Emanuel says.

How to Get Started

If you have questions about the flu shot or which vaccine is appropriate for you, talk to your doctor.

The 2026-2027 seasonal influenza vaccines are available and being rolled out at pharmacies, doctors’ offices, hospitals and clinics nationwide.

There are multiple options available, including egg-based standard dose flu shots, high-dose flu shots and cell-based shots. For the first time, there is also an mRNA flu shot available to those 50 and older this year (though the dementia reduction findings only apply to the other types of flu vaccines.)

They protect against three flu viruses (two influenza A and one influenza B strain), which are expected to circulate this winter.

The best time to get a flu vaccine is in late September or October, before flu activity peaks.

It takes about two weeks for the flu shot to take full effect, and this protection generally lasts about six months through the end of flu season.

TODAY’s Expert Tip of the Day series is all about simple strategies to make life a little easier. Every Monday through Friday, different qualified experts share their best advice on diet, fitness, heart health, mental wellness and more.

This article was originally published on TODAY.com

Development and validation of a machine learning model for predicting stroke-associated pneumonia in older patients with acute ischemic stroke

 What fucking stupidity; predicting pneumonia rather that creating a protocol to prevent it! You're all fired!

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)

Development and validation of a machine learning model for predicting stroke-associated pneumonia in older patients with acute ischemic stroke

• W

  Wen-Jie Chu 1

• S

  Si-Ran Zhang 2*

• Q

  Qi-Lun Lai 2

• J

  Jing-Ying Yu 2

• Y

  Yi-Qian Xu 2

• 1. Department of Hospital Infections, Zhejiang Hospital, Hangzhou, China

• 2. Department of Neurology, Zhejiang Hospital, Hangzhou, China

Abstract

Objective: 

Stroke-associated pneumonia (SAP) is a common and serious complication in older patients with acute ischemic stroke (AIS). However, early identification of high-risk patients remains challenging. This study aimed to develop and validate an interpretable machine learning model for predicting SAP risk in older AIS patients.

Methods: 

This retrospective study included 1,011 eligible patients (aged ≥65 years) with AIS who were consecutively admitted to Zhejiang Hospital in China from September 1, 2018, to December 31, 2023. A total of 1,011 patients were randomly divided into training and testing sets (7:3 ratio). Demographics, comorbidities, laboratory test results, and admission assessments were collected to evaluate the risk of SAP. The synthetic minority oversampling technique (SMOTE) was used to address the imbalanced training data. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to filter the predictive features. Eight machine learning models, including Logistic Regression (LR), Support Vector Machine (SVM), Light Gradient Boosting Machine (LightGBM), eXtreme Gradient Boosting (XGBoost), Categorical Boosting (CatBoost), Gradient Boosting Decision Tree (GBDT), Multi-layer Perceptron (MLP), and Random Forest (RF), were applied to identify the best prediction model. The optimal model was interpreted using the SHapley Additive exPlanations (SHAP).

Results: 

SAP incidence was 18.79%. LASSO identified 12 predictive features. The SVM demonstrated acceptable and stable predictive performance, achieving an accuracy of 0.773, sensitivity of 0.667, specificity of 0.798, F1 score of 0.524, Brier score of 0.156, and AUC of 0.794 (95% CI: 0.748–0.839) in the test set. SHAP analysis identified key factors influencing model predictions. An online platform was developed for clinical use.

Conclusion: 

This study demonstrates that an interpretable SVM-based machine learning model can effectively predict the risk of SAP in older patients with AIS using routinely available clinical and laboratory data. SHAP analysis further improved the model’s clinical interpretability by elucidating feature contributions. Our online prediction platform could serve as a promising tool for identifying high-risk older patients and facilitating the early prophylactic management of SAP.

Timing of nasogastric tube placement after endovascular thrombectomy and risk of stroke-associated pneumonia: a retrospective cohort study

 So nothing on preventing pneumonia via vaccine! Can't anyone in stroke actually think that stroke problems should be solved; NOT JUST DESCRIBED?

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)

Timing of nasogastric tube placement after endovascular thrombectomy and risk of stroke-associated pneumonia: a retrospective cohort study

• X

  Xiao-Fei Hu 1

• 

  Bai-Ling Pan 2

• 

  Li Han 1*

• 1. Department of Neurology, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China

• 2. Department of Endocrinology, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China

Abstract

Background: 

Stroke-associated pneumonia (SAP) is a common complication following endovascular thrombectomy (EVT), yet the impact of nasogastric tube (NGT) placement timing on SAP risk has not been examined.

Methods: 

We conducted a single-center retrospective cohort study of 331 patients who underwent successful EVT and received NGT placement between June 2022 and May 2025. The primary exposure was time from reperfusion to NGT placement. Multivariable logistic regression and restricted cubic splines were used to examine the association between NGT timing and SAP, adjusting for age, sex, admission NIHSS score, serum albumin, hypertension, atrial fibrillation, and diabetes mellitus.

Results: 

Stroke-associated pneumonia occurred in 227 patients (68.6%), reflecting the cohort’s restriction to EVT patients requiring NGT placement, a high-aspiration-risk subgroup. Each 12-h delay in NGT placement was associated with a 33% increase in the adjusted odds of SAP (aOR 1.33, 95% CI 1.06–1.68, p = 0.015). Patients with NGT placement more than 8 h after reperfusion had significantly higher odds of SAP than those with earlier placement (aOR 1.73, 95% CI 1.04–2.90, p = 0.036). Restricted cubic spline analysis demonstrated a monotonically increasing dose–response relationship (P overall = 0.073). The association appeared stronger in patients without atrial fibrillation (aOR 2.38) than in those with atrial fibrillation (aOR 1.08).

Conclusion: 

In EVT-treated patients requiring NGT placement, longer time to NGT insertion was associated with higher SAP risk after adjustment for measured covariates. These findings suggest that NGT placement timing may be a potentially modifiable factor in post-EVT care, and provide a hypothesis-generating basis for prospective evaluation.

Predicting pneumonia algorithm in stroke patients

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 (2 posts to October 2020)

 Predicting pneumonia algorithm in stroke patients

Jong Weon Lee^1,2Hyun-Joung Lee³Hyeon Ju Jang²Yeseul Yun⁴Deog Young Kim^1,2*

• ¹Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
• ²Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
• ³Department of Speech-Language Pathology, Wonkwang Digital University, Seoul, Republic of Korea
• ⁴Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea

Background: Pneumonia is a serious complication of stroke, particularly in patients with dysphagia during inpatient rehabilitation, as it significantly increases morbidity, prolongs hospital stays, and impairs functional recovery. Early identification of patients at risk for pneumonia is crucial for improving outcomes and reducing post-stroke complications. This study aimed to develop a comprehensive algorithm for predicting post-stroke pneumonia risk by integrating clinical assessments of defense mechanisms against pneumonia.

Methods: This case-control study enrolled stroke patients at a single tertiary hospital and followed them for 4 weeks to assess pneumonia incidence. A total of 812 patients aged 20 years or older with ischemic or hemorrhagic stroke and signs of dysphagia were screened. Of these, 484 were excluded based on the following criteria: inability to maintain a sitting posture with back support, dyspnea requiring oxygen supplementation, concurrent aspiration pneumonia before enrollment, infectious diseases requiring isolation, and refusal to participate. Final cohort of 328 patients was enrolled. All participants underwent evaluations, including a videofluoroscopic swallowing study (VFSS), a modified cough reflex test (mCRT), and assessments of nutritional status (serum albumin) and cognitive function [Mini-Mental State Examination (MMSE)]. Pneumonia was diagnosed using the Mann criteria, and predictive factors were analyzed using univariate logistic regression and classification and regression tree (CART) analysis.

Results: Among 328 participants, 28 (8.5%) developed pneumonia. Significant predictors included tracheostomy status (OR 9.34), VFSS-confirmed aspiration (OR 8.21) and bilateral stroke lesions (OR 5.91). CART analysis revealed tracheostomy, VFSS-confirmed aspiration, cough frequency, albumin levels, and MMSE scores as key predictors. The algorithm demonstrated a predictive accuracy of 92.7% with an AUC of 0.89 (95% CI: 0.82–0.95).

Conclusion: This study developed a highly accurate predictive algorithm for post-stroke pneumonia, emphasizing the role of defense mechanisms against pneumonia. Implementing this algorithm in clinical practice could enable early preventive measures, reduce pneumonia incidence, and improve patient outcomes.

Elevated systemic immune-inflammation index is associated with stroke-associated pneumonia in acute ischemic stroke: a retrospective cohort study

Fuck, we don't need predictions of pneumonia you blithering idiots, solve the problem of preventing that pneumonia in the first place.  I'd have you all fired.

You've known about this problem for a long time. GET THERE! 

Just maybe this vaccine!

Pneumonia Vaccine (3 posts to July 2020)

11% Stroke-associated pneumonia (2 posts to October 2020)

 Elevated systemic immune-inflammation index is associated with stroke-associated pneumonia in acute ischemic stroke: a retrospective cohort study

Tingting Duan¹Ming Yang¹Yiming Zhang^2†Chunyan Zhu^2†Zichen Rao^2*†

• ¹Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, China
• ²Department of Endocrinology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, China

Stroke-associated pneumonia (SAP) is a frequent complication of acute ischemic stroke (AIS) that contributes to poor clinical outcomes. The systemic immune-inflammation index (SII), derived from neutrophil, lymphocyte, and platelet counts, may reflect post-stroke immune imbalance, but its role in predicting SAP remains unclear. In this retrospective study, we analyzed 1,767 AIS patients and evaluated the association between log₂-transformed SII and the occurrence of SAP using multivariable logistic regression, generalized additive models, and two-piecewise regression. SAP developed in 21.3% of patients during hospitalization. Higher SII levels were independently associated with increased SAP risk after adjustment for age, sex, vascular risk factors, comorbidities, baseline National Institutes of Health Stroke Scale (NIHSS) score, and dysphagia assessed by Kubota Water Drinking Test (KWDT). Patients in the highest SII quartile had a significantly greater likelihood of developing SAP compared to those in the lowest quartile (adjusted odds ratio = 2.03, 95% confidence interval: 1.21–3.38, p = 0.0069). A non-linear, threshold-dependent relationship was identified, with SAP risk increasing substantially beyond log₂-SII ≈ 8.5. Receiver operating characteristic (ROC) analysis demonstrated moderate predictive performance of SII for SAP (area under the curve (AUC) = 0.726), while C-reactive protein (CRP) showed superior discrimination (AUC = 0.826 p < 0.0001). Supplementary sensitivity analyses, including a fully adjusted model without NIHSS and KWDT and an alternative model replacing these with the A2DS2 score (Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity), showed consistent results, supporting the robustness of our findings. These findings suggest that SII may serve as a cost-effective and accessible biomarker to aid early identification of high-risk AIS patients.

Introduction

Stroke remains one of the leading causes of mortality and long-term disability worldwide, with acute ischemic stroke (AIS) accounting for approximately 80% of all cases (1). Despite advances in acute stroke management, complications during hospitalization, particularly stroke-associated pneumonia (SAP), continue to pose significant challenges (2). SAP occurs in 10 to 30% of AIS patients and is closely associated with prolonged hospital stays, increased healthcare costs, and worse functional outcomes, including higher mortality rates (3). Early identification of high-risk patients is essential to guide preventative interventions and improve prognosis (4).

Emerging evidence suggests that systemic inflammation plays a pivotal role in the development of SAP by disrupting immune homeostasis and enhancing susceptibility to pulmonary infections following AIS (5). Conventional inflammatory biomarkers such as CRP, white blood cell (WBC) count, and neutrophil-to-lymphocyte ratio (NLR) have been widely used to assess systemic inflammation; however, their predictive accuracy for SAP remains suboptimal (6). The systemic immune-inflammation index (SII) calculated from platelet count, neutrophil count, and lymphocyte count, is a novel composite marker that reflects the balance between pro-inflammatory and immune-regulatory responses (7). Recent studies have demonstrated its prognostic value in various cardiovascular and oncologic conditions, but its predictive utility in SAP remains underexplored (8). In this study, we focused on SII as a comprehensive marker of immune-inflammatory balance, and compared it with CRP, a widely used reference biomarker in stroke research, to assess whether SII provides additional or complementary prognostic value beyond CRP. Moreover, existing studies evaluating inflammatory markers in SAP have primarily focused on linear relationships, potentially overlooking complex non-linear and threshold effects (9). For example, Kuang et al. (10) examined the association between SII and SAP risk in a smaller, mixed cohort of acute stroke patients and reported a linear relationship, without investigating potential non-linear patterns or thresholds. Whether elevated SII levels exhibit a dose–response relationship or specific thresholds beyond which SAP risk dramatically increases has not been fully elucidated. Addressing these knowledge gaps is critical for refining clinical risk stratification and informing targeted preventative strategies (11).

We posited that early elevation of the SII, as a marker of post-stroke immune disequilibrium, would identify AIS patients at independently higher risk of SAP, and that the exposure–response might be non-linear with a clinically relevant threshold. To test this hypothesis, we investigated the association between SII and the development of SAP in patients with AIS by analyzing a large, retrospective cohort. Specifically, we examined the predictive value of log₂-transformed SII, explored potential non-linear and threshold effects through advanced modeling approaches, and compared the diagnostic performance of SII with established inflammatory biomarkers such as CRP.

More at link.