A^2DS^2评分预测前循环和后循环缺血性卒中患者的卒中相关性肺炎

A^2DS^2 score predicts stroke-associated pneumonia in patients with anterior and posterior circulation ischemic stroke

目的探讨A^2DS^2评分预测前循环和后循环缺血性卒中患者卒中相关性肺炎(stroke-associated pneumonia, SAP)的价值。方法回顾性分析2011年6月至2016年3月期间在菏泽市立医院神经内科住院就诊的急性缺血性卒中患者的临床资料,通过二分类多变量logistic回归分析确定SAP的独立危险因素,通过受试者工作特征(receiver operator characteristic, ROC)曲线评估A^2DS^2评分预测前循环和后循环缺血性卒中患者SAP的价值。结果共纳入530例急性缺血性卒中患者,其中90例(16.98%)发生SAP。前循环卒中(n=430)和后循环卒中(n=100)患者SAP发生率差异无统计学意义(17.2%对16.0%;χ2=0.084,P=0.772)。二分类多变量logistic回归分析显示,A^2DS^2评分是缺血性卒中[优势比(odds ratio, OR)1.644,95%可信区间(confidence interval, CI)1.097~2.426]、前循环卒中(OR 1.593,95% CI 1.086~2.387)和后循环卒中(OR 1.463,95% CI 1.064~2.174)患者SAP的独立危险因素。ROC曲线显示,A^2DS^2评分预测缺血性卒中、前循环卒中和后循环卒中患者SAP的曲线下面积分别为0.826(95% CI 0.792~0.869)、0.821(95% CI 0.783~0.858)和0.832(95% CI 0.781~0.923),最佳截断值均为5分。A^2DS^2评分预测急性前循环和后循环缺血性卒中患者SAP的曲线下面积差异无统计学意义(Z=0.259,P=0.394)。结论A^2DS^2评分可无差别地预测缺血性卒中患者的SAP,无论是前循环还是后循环卒中患者,其最佳截断值均为5分。

Objective To investigate the value of A^2DS^2 score in predicting stroke-associated pneumonia (SAP) in patients with anterior and posterior circulation ischemic stroke. Methods The clinical data of patients with acute ischemic stroke admitted to the Department of Neurology, Heze Municipal Hospital from June 2011 to March 2016 were analyzed retrospectively. The independent risk factors for SAP were determined by binary multivariate logistic regression analysis. The value of A^2DS^2 score in predicting SAP in patients with anterior and posterior circulation ischemic stroke was evaluated by the receiver operator characteristic (ROC) curve. Results A total of 530 patients with acute ischemic stroke were enrolled, 90 of them (16.98%) had SAP. There was no significant difference in SAP incidence between the patients with anterior circulation stroke (n=430) and posterior circulation stroke (n=100)(17.2% vs. 16.0%;χ2=0.084, P=0.772). Binary multivariate logistic regression analysis showed that the A^2DS^2 score was an independent risk factor for SAP in patients with ischemic stroke (odds ratio [OR] 1.644, 95% confidence interval [CI] 1.097-2.426), anterior circulation stroke (OR 1.593, 95% CI 1.086-2.387), and posterior circulation stroke (OR 1.463, 95% CI 1.064-2.174). The ROC curve showed that the area under the curve of the A^2DS^2 score predicting SAP in patients with ischemic stroke, anterior circulation and posterior circulation stroke were 0.826 (95% CI 0.792-0.869), 0.821 (95% CI 0.783-0.858), and 0.832 (95% CI 0.781-0.923), respectively. The best cut-off value was 5. There was no significant difference in the area under SAP curve of the A^2DS^2 score for predicting SAP between patients with acute anterior circulation and posterior circulation ischemic stroke (Z=0.259, P=0.394). Conclusion A^2DS^2 score could predict SAP in patients with anterior circulation and posterior circulation stroke without difference, both of the cut-off value was 5.