Stroke-Associated Pneumonia and Impaired Functional Recovery After Stroke: The Role of Nutritional-Inflammatory...

Stroke-associated pneumonia (SAP) is a common complication after acute ischemic stroke and contributes to worse recovery and greater resource use. Nutritional and inflammatory dysregulation have been implicated in both SAP susceptibility and adverse prognosis.

To examine whether admission inflammatory and nutritional markers are associated with the development of SAP and with short-term functional prognosis.

We performed a retrospective single-centre cohort study of consecutive patients with acute ischemic stroke admitted between 1 January 2015 and 31 December 2024 (N=303;SAPn=108,non-SAPn=195). Admission laboratory indices (albumin, CRP, fibrinogen, WBC, PCT, and prealbumin) in the first 24 h and clinical variables were analysed. Multivariable logistic regression identified factors independently associated with SAP; the relationship between SAP and early functional recovery was assessed in adjusted outcome models. A nomogram integrating key predictors was developed and its apparent discrimination is reported.

SAP occurred in 35.6% of patients. Factors independently associated with SAP included nasogastric tube placement (OR: 7.02, 95% CI: 3.50-14.62), venous thromboembolism (OR: 3.20, 95% CI: 1.62-6.31), cognitive impairment (OR: 2.90, 95% CI: 1.32-6.36), and elevated inflammatory markers (WBC OR: 1.52, 95% CI: 1.28-1.80; fibrinogen OR: 1.37, 95% CI: 1.02-1.84; CRP OR: 1.01, 95% CI: 1.00-1.03). Higher admission serum albumin was associated with lower odds of SAP (OR: 0.92, 95% CI: 0.86-0.98). The nomogram showed strong apparent discrimination (AUC: 0.90, 95% CI: 0.86-0.94). After multivariable adjustment, SAP remained associated with poorer short-term functional improvement (adjusted OR: 6.99, 95% CI: 3.05-17.54) and greater healthcare utilization (median length of stay: 39.6 vs. 30.6 days; median cost: USD 12,836 vs. 6585).

In this retrospective cohort, admission markers of nutritional depletion and inflammatory activation were associated not only with increased likelihood of SAP, but also with adverse early functional outcomes. These association-based findings support early risk stratification using routine admission markers; prospective studies and external validation are required before clinical implementation.