Temporal Profile of Pneumonia After Stroke

Area of Science:

• Neurology
• Infectious Diseases
• Critical Care Medicine

Background:

• Pneumonia following stroke is a major contributor to mortality and adverse patient outcomes.
• Understanding the timing of post-stroke pneumonia is essential for developing effective prevention strategies.

Purpose of the Study:

• To analyze the temporal pattern of pneumonia occurrence after acute stroke.
• To determine the optimal time window for evaluating pneumonia prevention interventions.
• To assess the association between pneumonia and poor outcomes or death at various time points.

Main Methods:

• Individual patient data from the Virtual International Stroke Trials Archive (VISTA) were analyzed.
• The study included randomized acute stroke trials with an early inclusion window (up to 24 hours).
• Pneumonia occurrence within 90 days post-stroke was assessed, with statistical analysis using logistic and Cox regression.

Main Results:

• Pneumonia occurred in 9.4% of 10,821 patients, with 64% happening in the first week post-stroke.
• The peak incidence of pneumonia was on day 3, with a median onset of 4.0 days.
• Pneumonia significantly increased the risk of poor outcome (aOR=4.8) and death (aHR=4.1) throughout the 90-day follow-up.

Conclusions:

• Two-thirds of post-stroke pneumonias occur within the first week, peaking on the third day.
• The optimal period for assessing pneumonia prevention strategies is the initial 4 days after stroke.
• Late-onset pneumonia also remains a significant risk factor for poor functional outcomes and mortality.