Post-Stroke Aspiration Pneumonia in Riyadh, Saudi Arabia: A Retrospective Cohort Study

Stroke is a leading cause of morbidity among patients with neurological disorders. Post-stroke aspiration pneumonia (AP) represents a serious complication associated with high mortality. This study investigated the incidence and outcomes of AP at a tertiary care center.

Retrospectively, among 5921 adult patients admitted with ischemic or hemorrhagic stroke between February 2016 and January 2024, 118 who developed post-stroke aspiration pneumonia within the same admission or at a 90-day period were identified and analyzed. Univariate and multivariate analyses were done.

Among 5921 stroke patients, 118 developed post-stroke AP. The mean age was 69.5 ± 12.5 years, and 71 (60.2%) were male. Hypertension (72.9%) and diabetes mellitus (63.6%) were the most prevalent comorbidities. Ischemic stroke accounted for 79.7%, and the median NIHSS was 9 (IQR 4-15). The median pre-morbid mRS was 2 (IQR 0-5). Dysphagia was diagnosed in 54.2%, and a swallowing assessment was performed and documented in 73.5%. Common presenting features included fever (55.9%), altered consciousness (47.5%), and cough (43.2%). Median time from stroke to AP was 6 days (IQR 2-22). ICU admission was required in 46.6%, mechanical ventilation in 24.1%, and 58.5% were bedridden. In-hospital mortality was 22.0%. On multivariate logistic regression, lower GCS score was the only independent predictor of mortality (OR 0.777, 95% CI 0.629-0.959, p = 0.019).

Post-stroke AP remains a significant complication, with a notable mortality rate. A lower GCS score independently predicted mortality, whereas ICU admission was significant only in the univariate analysis. The overall incidence of AP in our study was lower than rates reported in other populations, possibly reflecting differences in clinical practices, patient characteristics, or variability in diagnostic ascertainment rather than a true reduction in incidence.