Risk factors for stroke-associated pneumonia after endovasular treatment in acute anterior circulation ischemic stroke patients

To investigate the influencing factors for stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients after endovascular treatment (EVT).

A retrospective case-control trial was conducted on 426 AIS patients with large vessel occlusion (LVO) in anterior circulation admitted in the neurological departments from First Affiliated Hospital of Army Medical University and Zigong Third People’s Hospital during January 2017 and April 2021. Based on SAP occurrence or not, they were divided into an SAP group and a non-SAP group. Demographic information (gender and age), TOAST stroke subtypes (large artery atherosclerosis type, cardiac embolism type, others), vascular risk factors (hypertension, hyperlipidemia, diabetes, atrial fibrillation, smoking, prior stroke history, smoking), and post-onset clinical data [dysphagia, LDL cholesterol, white blood cells, neutrophils, baseline and postoperative NIHSS scores, endovascular outcomes (mTICI grade 2b or 3), 90-day good prognosis (mRS 0-1)] were collected and compared between the 2 groups. Multivariate logistic regression analysis was performed using the parameters with P< 0. 1 in univariate analysis as independent variables to investigate factors influencing SAP occurrence after EVT in AIS patients.

Among the 426 participants, SAP occurred in 194 cases (45. 5%). Multivariate logistic regression analysis revealed that admission white blood cell count (OR=1.125, 95% CI: 1.043~1.213, P=0.0002), postoperative NIHSS score (OR=1.019, 95% CI: 1.001~1.037, P=0.041), and male (OR=1.687, 95% CI:1.078~2.638, P=0.022) were associated with SAP occurrence after EVT in AIS patients.

Higher admission white blood cell count, elevated postoperative NIHSS score, and male gender are risk factors for SAP in AIS patients after EVT. These risk factors should be focused on clinical practice to control SAP incidence.