Value of Combination of the A(2)DS(2) Score and IL-6 in Predicting Stroke-Associated Pneumonia

PURPOSE: To evaluate the value of the combination of the age, atrial fibrillation, dysphagia, male sex, and National Institutes of Health Stroke Scale (A(2)DS(2)) score and serum interleukin 6 (IL-6) concentration in predicting stroke-associated pneumonia (SAP). PATIENTS AND METHODS: A total of 398 patients with acute ischemic stroke (AIS) from the medical ward was included in this retrospective study. They were divided into the SAP group and non-SAP group according to the diagnostic criteria of SAP. Multivariate analysis was performed to analyze the association between the A(2)DS(2) score, serum IL-6 concentration, and SAP using a backward stepwise logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the value of the A(2)DS(2) score, serum IL-6 concentration and combination of A(2)DS(2) score and IL-6 in predicting SAP. RESULTS: SAP was diagnosed in 70 patients (17.6%). Multivariate analysis showed that the A(2)DS(2) score (odds ratio [OR]: 2.25, 95% confidence interval [CI]: 1.17–4.99, P=0.017) and serum IL-6 concentration (OR: 1.76, 95% CI: 1.44–1.95, P<0.001) was independently associated with SAP after adjusting for age, smoking, hypertension, hyperlipidemia, and atrial fibrillation. When the A(2)DS(2) score, serum IL-6 concentration and combination of A(2)DS(2) score and IL-6 were employed to predict SAP, the AUC was 0.824 (SE: 0.026, 95% CI: 0.773–0.875), 0.715 (SE: 0.034, 95% CI: 0.641–0.788) and 0.917 (SE: 0.015, 95% CI: 0.887–0.946), respectively. The AUC of combinative prediction was significantly higher than independent prediction (0.917 vs. 0.824, Z=3.098, P<0.001; 0.917 vs. 0.715, Z=5.436, P<0.001). CONCLUSION: The addition of serum IL-6 to the A(2)DS(2) score could significantly enhance the AUC of predicting SAP in AIS patients from the medical ward.