ABSTRACT
Objective To explore the independent risk factors related to acute post-stroke pneumonia.Methods A total of 545 inpatients with acute stroke in Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University and East Hospital Affiliated to Tongji University during July 1,2009 to June 30,2011 were enrolled.Single-factor analysis was performed to identify the risk factors of acute post-stroke pneumonia. According to the results of single-factor analysis and relevant professional knowledge,fitting multi-factor non-conditional Logistic regression model,adjusting the relevant confounded factors,the independent risk factors were analyzed.Results The incidence of acute post-stroke pneumonia was 11.0％ (60/545).The independent risk factors of acute post-stroke pneumonia were:age ≥ 80 year ( OR =6.024,95％ CI:1.923 - 18.868,P =0.002 ),hemorrhagic stroke ( OR =3.546,95％ CI:1.266 -9.901,P =0.016),stay in bed ( OR =4.295,95％ CI:1.642 - 11.233,P =0.003 ),baseline Glasgow coma scale ≤8 ( OR =5.127,95％ CI:1.377 - 19.090,P =0.015 ),baseline Barthel index ＜50 ( OR =8.403,95％ CI:1.468 -47.619,P =0.017 ),malnutrition ( OR =10.625,95％ CI:3.260 -34.631,P =0.000 ),baseline fasting plasma glucose ≥ 7.0 mmol/L ( OR =10.000,95％ CI:3.115 -32.258,P =0.000); and early rehabilitation was the protective factor (OR =0.159,95％ CI:0.055 -0.466,P =0.001 ).Conclusions The incidence of acute post-stroke pneumonia is high,and it is relatedwith many independent risk factors.Comprehensive interventions may contribute to early identify and prevent acute post-stroke pneumonia.
ABSTRACT
Infection is one of the most important complications of acute stroke, and it is an independent risk factor for resulting in stroke worsening. Growing evidence has indicated that acute stroke patients suffer an impaired peripheral immune response, i.e. stroke-induced immunodepression system (SIDS). SIDS is characterized by the rapid and sustained cellular immunodepression after acute stroke, which is mainly presented as wide apoptosis and dysfunction of lymphocyte. Multiple reasons activate the sympathetic nervous system, and thus cause SIDS. SIDS weakens the effective defense against the invasion of pathogens in the human body, resulting in the increased infection and mortality rate. However, SIDS also has protective effect on the human body. It can prevent the excessive inflammatory response in the injured brain tissue. A better understanding of the complex relationships between the central nervous system and the immune system are promising to provide more effective treatment methods for patients with acute stroke.
ABSTRACT
Objective To investigate the detection rate of malnutrition among post-stroke patients in community hospitals and unravel the relevant factors that precipitate malnutrition after stroke. Methods Based on 438 post-stroke patients who were admitted in community hospitals, we examined the demographic characteristics, the nutritional indices and the possible malnutrition related factors through a cross-sectional study.Results The detection rate of malnutrition among post-stroke patients was 52.7%. Group comparison through multivariate logistic regression analysis showed that there was a higher malnutrition detection rate in the post-stroke patients with multiple stroke attacks (three stroke attackes and above, OR = 11.00,95%CI 1. 14-106.34), higher NIHSS scores (group with NIHSS≥15, OR=7.09, 95% CI 2.90-17.36) , higher modified Rankin scales (group mRS 4-5, OR = 15. 77,95% CI 6.61-37.59) (trend test P<0.0001) .The risk of malnutrition was also correlated with the post-stroke depression, poorer family care, no early-stage rehabilitation, history of malignant tumors and severe alcoholism. Conclusions There is a high detection rate of malnutrition among post-stroke patients in community hospitals. There are many factors related to malnutrition among post-stroke patients in the community. More attention to controllable influencing factors would improve the prognosis of post-stroke patients.