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Impact of Pneumonia on Rehabilitation Outcomes: A Large Observational Study
Van Giap Vu1,2, Thi Linh Tran3, Viet Phuong Dao4,5,6
1Respiratory Department, Hanoi Medical University, Hanoi.
Objective:
To evaluate the effect of poststroke pneumonia on rehabilitation outcomes in patients with acute stroke.
Design:
A prospective observational cohort study.
Setting:
Rehabilitation services for patients with stroke across 3 hospitals in a low and middle-income country.
Participants:
A total of 922 patients with stroke (N=922) were enrolled (median age: 67y; 63.7% men) and classified into poststroke pneumonia (PSP; n=296) and nonpneumonia (PSNP; n=626) groups. The patients with PSP were further divided into 2 subgroups based on onset timing including stroke-associated pneumonia (SAP; n=157), defined as diagnosis within 7 days of stroke onset, and hospital-acquired pneumonia (HAP; n=139), defined as pneumonia diagnosed after 7 days.
Interventions:
Not applicable.
Main Outcome Measures:
Primary outcome analysis focused on functional outcomes (modified Rankin Scale [mRS]), hospital length of stay (LOS), and mortality were assessed at discharge, 3 months, and 6 months after stroke. Secondary analysis explored predictors of functional outcomes.
Results:
Patients with PSP demonstrated significantly poorer functional outcomes, with higher mRS scores (≥3) at discharge, 3 months, and 6 months (P<.001). However, HAP showed stronger association with poor outcomes (odds ratio [OR]≥3) than SAP. Mortality was higher in the PSP group compared with the PSNP group at 3 months (OR=4.98; 95% CI, 2.1-11.7, P<.001) and 6 months after stroke (OR=5.4; 95% CI, 2.3-12.6, P<.001). HAP also associated with a longer LOS (24.18±7.81d) than SAP (19.5±8.26d; P<.001). Stroke severity remained a strong predictor of outcomes in this study.
Conclusions:
Poststroke pneumonia worsens rehabilitation outcomes, prolongs LOS, and increases mortality. Early pneumonia prevention and multidisciplinary integrated rehabilitation, aligned with World Health Organization (WHO) standards, are essential to improve stroke recovery and reduce complications in low- and middle-income countries.
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