Elena Zapata-Arriaza1, Francisco Moniche1, Pardo-Galiana Blanca1, Alejandro Bustamante2, Irene Escudero-Martínez1, Oscar Uclés1, Ángela Ollero-Ortiz3, Jose Antonio Sánchez-García4, Miguel Ángel Gamero5, Ángeles Quesada5, Diana Vidal De Francisco6, Mercedes Romera7, Carlos De la Cruz8, Gema Sanz9, Joan Montaner10. 1. Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio and Macarena, Seville, Spain. 2. Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain. 3. Neurology Department, Serranía de Ronda Hospital, Ronda, Spain. 4. Neurology Department, Málaga Regional Hospital, Málaga, Spain. 5. Neurology Department, University Hospital Virgen de Macarena, Seville, Spain. 6. Neurology Department, Jaen Hospital Complex, Jaen, Spain. 7. Neurology Department, University Hospital Virgen de Valme, Seville, Spain. 8. Neurology Department, University Hospital Virgen de la Victoria, Málaga, Spain. 9. Neurology Department, Huelva Universitary Hospital Complex, Huelva, Spain. 10. Neurology Department, Biomedicine Institute of Seville (IBIS), University Hospital Virgen del Rocio and Macarena, Seville, Spain. Electronic address: jmontaner-ibis@us.es.
Abstract
BACKGROUND: The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN), Age, Atrial Fibrillation, Dysphagia, male sex, and National Institutes of Health Stroke Scale (A2DS2), and acute ischemic stroke-associated pneumonia score (AIS-APS) scores were created to predict stroke-associated pneumonia (SAP), one of the most important medical stroke complications. External validation of all such scores in an acute stroke population was the aim of our study. METHODS: Patients with ischemic or hemorrhagic stroke were prospectively enrolled in the multicenter Stroke-Induced Pneumonia in Andalucía project between October 2014 and May 2016. Receiver operating characteristic curves and linear regression analyses were used to determine discrimination ability of the scores. The Hosmer-Lemeshow goodness-of-fit test and the plot of observed versus predicted SAP risk were used to assess model calibration. RESULTS: Among 201 included patients, SAP rate was 15.5% (31). Higher ISAN, A2DS2, and AIS-APS scores were related to SAP (all P < .001). The C statistic was .83 (95% confidence interval [CI], .76-.91) for the ISAN score, .80 (95% CI, .70-.89) for the A2DS2 score, and .82 (95% CI, .74-.90) for the AIS-APS score, suggesting good discrimination. The ISAN and AIS-APS scores showed good calibration (Cox and Snell R2 = .206 and .174, respectively). The A2DS2 score showed the highest sensitivity (87%), and the AIS-APS score showed the highest specificity (92.8%). CONCLUSIONS: In our cohort, the external validation of ISAN, A2DS2, and AIS-APS scores have demonstrated their accurate prediction of SAP and the ability of these scores as screening tools to better manage SAP. The AIS-APS score would be recommendable for the development of future clinical trials.
BACKGROUND: The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN), Age, Atrial Fibrillation, Dysphagia, male sex, and National Institutes of Health Stroke Scale (A2DS2), and acute ischemic stroke-associated pneumonia score (AIS-APS) scores were created to predict stroke-associated pneumonia (SAP), one of the most important medical stroke complications. External validation of all such scores in an acute stroke population was the aim of our study. METHODS:Patients with ischemic or hemorrhagic stroke were prospectively enrolled in the multicenter Stroke-Induced Pneumonia in Andalucía project between October 2014 and May 2016. Receiver operating characteristic curves and linear regression analyses were used to determine discrimination ability of the scores. The Hosmer-Lemeshow goodness-of-fit test and the plot of observed versus predicted SAP risk were used to assess model calibration. RESULTS: Among 201 included patients, SAP rate was 15.5% (31). Higher ISAN, A2DS2, and AIS-APS scores were related to SAP (all P < .001). The C statistic was .83 (95% confidence interval [CI], .76-.91) for the ISAN score, .80 (95% CI, .70-.89) for the A2DS2 score, and .82 (95% CI, .74-.90) for the AIS-APS score, suggesting good discrimination. The ISAN and AIS-APS scores showed good calibration (Cox and Snell R2 = .206 and .174, respectively). The A2DS2 score showed the highest sensitivity (87%), and the AIS-APS score showed the highest specificity (92.8%). CONCLUSIONS: In our cohort, the external validation of ISAN, A2DS2, and AIS-APS scores have demonstrated their accurate prediction of SAP and the ability of these scores as screening tools to better manage SAP. The AIS-APS score would be recommendable for the development of future clinical trials.
Authors: Elena Zapata-Arriaza; Fernando Mancha; Alejandro Bustamante; Francisco Moniche; Blanca Pardo-Galiana; Pilar Serrano-Gotarredona; Silvia Navarro-Herrero; Esther Pallisa; Julia Faura; Ángela Vega-Salvatierra; Anna Penalba; Irene Escudero-Martínez; Víctor Darío Ramos-Herrero; Leire Azurmendi; Jean Charles Sanchez; Joan Montaner Journal: Ann Clin Transl Neurol Date: 2019-07-31 Impact factor: 4.511
Authors: Chiara Robba; Denise Battaglini; Cynthia S Samary; Pedro L Silva; Lorenzo Ball; Patricia R M Rocco; Paolo Pelosi Journal: Intensive Care Med Exp Date: 2020-12-18