Risk estimation for stroke-associated pneumonia in acute ischemic stroke: a nomogram-based approach

Stroke-associated pneumonia (SAP) is a common complication in patients with acute ischemic stroke (AIS), leading to higher mortality and poor functional outcomes. Early identification of at-risk individuals is critical for timely interventions.

To identify the independent risk factors for SAP in AIS patients and to develop a predictive nomogram for early risk stratification.

We conducted a retrospective analysis of 280 AIS patients admitted between January 2021 and August 2025. Multivariable logistic regression identified independent SAP risk factors, and a nomogram was developed. Model performance was evaluated through receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). Internal validation was performed using bootstrap resampling (1 thousand iterations).

The incidence of SAP was of 30.0% (84/280). The independent risk factors included advanced age, atrial fibrillation, higher score on the National Institutes of Health Stroke Scale (NIHSS), nasogastric tube insertion, mechanical ventilation, and elevated monocyte-to-lymphocyte ratio (MLR). Higher albumin levels were protective. The nomogram showed good discrimination (area under the curve [AUC]= 0.816; 95%CI: 0.765-0.871), satisfactory calibration, and favorable clinical usefulness, as demonstrated by the DCA.

We developed a nomogram to predict SAP risk in AIS patients. The key risk factors included advanced age, atrial fibrillation, NIHSS score, nasogastric tube insertion, mechanical ventilation, and elevated MLR, while higher albumin levels were protective. The nomogram demonstrated strong discriminatory power and clinical usefulness, supporting early risk stratification and targeted interventions.