Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study
Sarah Hoffmann1,2, Hendrik Harms3, Lena Ulm1
11 NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.
Summary
Stroke-associated pneumonia is a common complication. This study found that both dysphagia and stroke-induced immunodepression syndrome, indicated by low monocytic HLA-DR, independently increase pneumonia risk after stroke.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Stroke-associated pneumonia (SAP) is a frequent complication with poor outcomes.
- While dysphagia is a known risk factor for SAP, stroke itself may induce immune suppression, increasing susceptibility.
- Monocytic HLA-DR expression is a potential marker for stroke-induced immunodepression syndrome (SIIDS).
Purpose of the Study:
- To investigate if SIIDS, indicated by monocytic HLA-DR expression, predicts SAP independently of dysphagia.
- To assess the predictive value of inflammation (IL-6) and infection (LBP) biomarkers for SAP.
- To identify high-risk patients for SAP after acute ischemic stroke.
Main Methods:
- Prospective, multicenter study involving 486 patients with acute ischemic stroke in Germany and Spain.
- Daily screening for SAP, dysphagia, and biomarkers including monocytic HLA-DR, IL-6, and LBP.
- Multivariable regression analysis to determine independent predictors of SAP.
Main Results:
- The overall frequency of SAP was 5.2%.
- Both dysphagia and decreased monocytic HLA-DR expression were independent predictors of SAP.
- Patients with dysphagia and low monocytic HLA-DR had the highest SAP risk (18.8%), while those without either risk factor had none.
Conclusions:
- Dysphagia and SIIDS are independent risk factors for SAP.
- Screening for dysphagia and immune suppression (monocytic HLA-DR) can identify patients at high risk for SAP.
- These findings support targeted interventions to prevent SAP in high-risk stroke patients.
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