Frailty combined with nutritional risk for predicting stroke-associated pneumonia: a cohort study based on a nomogram...

Area of Science:

• Neurocritical care
• Pulmonology
• Geriatrics

Background:

• Stroke-associated pneumonia (SAP) is a frequent and severe complication in acute severe stroke patients.
• Existing risk assessment tools lack predictive accuracy in critically ill populations.
• Frailty and nutritional risk reflect physiological reserve and stress tolerance, crucial factors in SAP development.

Purpose of the Study:

• To develop and validate an early prediction model for SAP in critically ill stroke patients.
• To investigate the additive interaction between frailty and nutritional risk in SAP development.
• To improve risk stratification for precision prevention and targeted interventions.

Main Methods:

• Retrospective cohort study of 293 critically ill stroke patients.
• Assessment of clinical characteristics, laboratory indicators, frailty status, and nutritional risk.
• Multivariate logistic regression for predictor identification and nomogram construction.
• Model performance evaluation using AUC, calibration plots, and decision curve analysis.

Main Results:

• A total of 126 (43%) patients developed SAP.
• Significant additive interaction observed between frailty and nutritional risk (SI = 3.694).
• The novel prediction model (AUC = 0.848) significantly outperformed the ISAN score (AUC = 0.589).
• Internal validation demonstrated good accuracy (73.93%), sensitivity (77.30%), and specificity (71.95%).

Conclusions:

• The integration of frailty and nutritional risk into an SAP prediction model enhances early risk identification.
• This innovative model offers a practical tool for precision prevention and targeted interventions in critically ill stroke patients.
• The findings highlight the importance of assessing frailty and nutritional status in stroke patients at risk for pneumonia.