Prediction on neurological deterioration based on imaging features in patients with stroke-associated pneumonia

doi:10.3969/j.issn.1006-7795.2022.01.014

Abstract

Abstract: Objective To investigate the risk factors for the occurrence of neurological deterioration (ND) in patients with stroke-associated pneumonia (SAP) and to establish a predictive model using imaging features. Methods We retrospectively recruited SAP patients admitted to emergency or neurology departments during January to December 2020, and SAP patients were divided into ND and non-ND groups according to whether the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥ 4 (total) during hospitalization. The clinical characteristics, laboratory tests, brain and lung imaging features of the two groups were compared. Variables with a P value<0.05 by univariate analysis were included in Logistic regression analysis. Results We retrospectively recruited 73 SAP patients. ND was diagnosed in 15 patients (20.54%). The chest computed tomography (CT) score, large infarction, thalamic infarction and occipital lobe infarction were significantly different between the two groups (P<0. 05). In particular, chest CT score (OR=1.218,95%CI:1.010-1.469), thalamic infarction (P<0.05, OR=10.016, 95%CI:1.523-65.862) and large cerebral infarction (P<0.05, OR=9.033, 95%CI:1.746-46.742) were independent risk factors for the occurrence of ND. For prediction of ND, the area under curve (AUC) of the logistic model was 0.849 (95% CI:0.752-0.947); the AUC of chest CT score was 0.744 (95% CI:0.611-0.878) with sensitivity 80.00%, specificity 63.80%, predictive positive value (PPV) 36.36%,predictive negative value (PNV) 92.50%, accuracy 67.12%; the AUC of thalamic infarction was 0.624 (95% CI :0.450-0.797), with sensitivity 33.33%, specificity 91.38%, PPV 50.00%, PNV 84.13%, accuracy 79.45%; and the AUC of combined large infarction and chest CT score was 0.799 (95%CI:0.690-0.909) with sensitivity 100.00%, specificity 48.28%, PPV 33.33%, PNV 100.00%, accuracy 58.9%. Conclusion Our study indicated that chest CT score, thalamic infarction and large cerebral infarction may be independently associated with ND in SAP. The chest CT score may predict ND in SAP patients with higher sensitivity and accuracy, what's more, the higher the chest CT score (>4.5), the more likely to develop ND in SAP patients. Thalamic infarction may predict ND in SAP patients with higher specificity and accuracy. The combined analysis of chest CT score and lesion size of infarction can help clinicians to stratify the SAP patients with higher risk to develop ND.

Key words: stroke-associated pneumonia, neurological deterioration, thalamic infarction, chest computed tomography (CT) score, large cerebral infarction

CLC Number:

R445

Sun Penghui, Li Yingying, Liu Xin, Jia Xuejia, Jia Xiuqin, Yang Qi. Prediction on neurological deterioration based on imaging features in patients with stroke-associated pneumonia[J]. Journal of Capital Medical University, 2022, 43(1): 74-81.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2022.01.014

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2022/V43/I1/74

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