To analyze the risk factors of nosocomial pulmonary infection in elderly patients with spontaneous intracerebral hemorrhage (sICH) and evaluate their impact on prognosis.

Clinical data were collected of 208 elderly patients with sICH admitted to Handan First Hospital from March 2021 to September 2024. According to the occurrence of pulmonary infection during hospitalization, the patients were divided into an infection group and a non-infection group. Baseline data, including comorbidities and admission examinations, and short-term prognosis at 90 d after admission, were compared between two groups. SPSS 25.0 was used for statistical analysis. Data comparison between two groups was performed using t-test, χ² test, or rank-sum test depending on data type. Multivariate logistic regression analysis was used to evaluate the risk factors of nosocomial pulmonary infection in elderly sICH patients.

The incidence of nosocomial pulmonary infection in 208 elderly sICH patients was 26.44% (55/208). The differences were statistically significant between the infection group and the non-infection group in chronic obstructive pulmonary disease, tracheal intubation and blend sign, any hypodensity, timing (BAT) score on non-contrast computed tomography (NCCT), National Institutes of Health Stroke Scale (NIHSS) score, and modified frailty index (mFI) score (all P<0.05). The infection group had higher mortality rate at 90 d after admission and proportion of modified Rankin Scale (mRS) score >2 points than the non-infection group (14.55% vs 3.92%; 70.91% vs 47.06%) (both P<0.05). Multivariate logistic regression analysis showed that chronic obstructive pulmonary disease (OR=2.627, 95%CI 1.251–5.520), tracheal intubation (OR=3.469, 95%CI 2.036–5.911), BAT ≥3 points (OR=2.855, 95%CI 1.494–5.456), NIHSS ≥15 points (OR=3.920, 95%CI 2.315–6.636), and mFI ≥3 points (OR=4.632, 95%CI 2.753–7.794) were risk factors of nosocomial pulmonary infection in elderly sICH patients (P<0.05).

Elderly sICH patients with chronic obstructive pulmonary disease as an underlying disease, high BAT score, high NIHSS score, and high mFI score on admission, and tracheal intubation are more likely to have nosocomial pulmonary infection, and the prognosis of those with secondary nosocomial pulmonary infection is worse. It is necessary to strengthen clinical management of the above high-risk factors to reduce the incidence of nosocomial pulmonary infection.