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Risk estimation for stroke-associated pneumonia in acute ischemic stroke: a nomogram-based approach
Jiao Wang1, Shuai Zhang2, Yueguang Cheng1
1Beijing Jingmei Group General Hospital, Department of Emergency Medicine, Beijing, China.
Arquivos De Neuro-Psiquiatria
|May 18, 2026
Summary
Stroke-associated pneumonia (SAP) is common after acute ischemic stroke (AIS). A predictive nomogram identifies high-risk patients using factors like age, atrial fibrillation, and NIHSS score, enabling early intervention.
Area of Science:
- Neurology
- Critical Care Medicine
- Pulmonology
Background:
- Stroke-associated pneumonia (SAP) is a frequent and serious complication following acute ischemic stroke (AIS).
- SAP significantly increases mortality rates and leads to poorer functional outcomes in stroke survivors.
- Early identification of patients at risk for SAP is crucial for implementing timely and effective interventions.
Purpose of the Study:
- To pinpoint independent risk factors contributing to SAP development in acute ischemic stroke patients.
- To create a predictive nomogram for the early and accurate risk stratification of SAP in this population.
Main Methods:
- A retrospective analysis was performed on 280 patients admitted with AIS.
- Multivariable logistic regression identified independent risk factors for SAP.
- A predictive nomogram was developed and validated using ROC curve analysis, calibration plots, and decision curve analysis (DCA).
Main Results:
- The incidence of SAP was 30.0% (84/280 patients).
- Independent risk factors for SAP included advanced age, atrial fibrillation, higher NIHSS scores, nasogastric tube insertion, mechanical ventilation, and elevated monocyte-to-lymphocyte ratio (MLR).
- Higher albumin levels demonstrated a protective effect against SAP. The nomogram achieved an AUC of 0.816.
Conclusions:
- A validated nomogram can effectively predict SAP risk in AIS patients.
- Key predictors include advanced age, atrial fibrillation, NIHSS score, nasogastric tube insertion, mechanical ventilation, and elevated MLR, with albumin as a protective factor.
- This tool supports early risk stratification and facilitates targeted interventions to improve patient outcomes.
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