Leukoaraiosis is associated with pneumonia after acute ischemic stroke

Stroke-associated pneumonia (SAP) is common in patients with acute ischemic stroke, and several risk factors have been reported. However, the relationship between underlying leukoaraiosis (LA) and SAP has not been addressed.

We collected consecutive patients with acute ischemic stroke within 24 h of symptom onset. SAP was defined as the lower respiratory tract infection within the first 7 days after stroke onset, according to the modified Centers for Disease Control and Prevention criteria. LA was graded using the Fazekas scale in both the periventricular and subcortical areas. We evaluated LA burden by summing the grade and dichotomized into mild LA (0-2) or severe LA (3-6). Relationship between LA and SAP was analyzed by binary logistic regression analysis with variables of P < 0.05 in univariate analysis.

Three hundred eight consecutive patients were enrolled, and SAP developed in 44 patients (14%). Univariate analysis revealed that SAP correlated with age, initial NIHSS score, atrial fibrillation, impaired consciousness, dysphagia, severe LA and hyperlipidemia. On multivariate analysis, severe LA [adjusted OR (aOR) = 4.41, 95% CI = 2.04-9.55, P < 0.001 remained independent predictors of SAP after adjusted confounders.

In this study, LA was an independent predictor of SAP. This observation needs to be confirmed in suitably-designed, prospective studies.