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Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections

Stroke has been a leading cause of mortality in China. Stroke-associated infections (SAI) are common complications, occurring in 5–65% of stroke patients. Faced with SAI, clinicians often are placed in a considerable dilemma. On the one hand, preventive overuse of antibiotics will lead to the emerge...

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Autores principales: Lan, Yan, Sun, Wenzhe, Chen, Yuxi, Miao, Jinfeng, Li, Guo, Qiu, Xiuli, Song, Xiaoyan, Zhao, Xin, Zhu, Zhou, Fan, Yebin, Zhu, Suiqiang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667237/
https://www.ncbi.nlm.nih.gov/pubmed/33224089
http://dx.doi.org/10.3389/fneur.2020.574280
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author Lan, Yan
Sun, Wenzhe
Chen, Yuxi
Miao, Jinfeng
Li, Guo
Qiu, Xiuli
Song, Xiaoyan
Zhao, Xin
Zhu, Zhou
Fan, Yebin
Zhu, Suiqiang
author_facet Lan, Yan
Sun, Wenzhe
Chen, Yuxi
Miao, Jinfeng
Li, Guo
Qiu, Xiuli
Song, Xiaoyan
Zhao, Xin
Zhu, Zhou
Fan, Yebin
Zhu, Suiqiang
author_sort Lan, Yan
collection PubMed
description Stroke has been a leading cause of mortality in China. Stroke-associated infections (SAI) are common complications, occurring in 5–65% of stroke patients. Faced with SAI, clinicians often are placed in a considerable dilemma. On the one hand, preventive overuse of antibiotics will lead to the emergence of drug-resistant bacteria. On the other hand, treatment delay of the infection will likely result in a poor outcome. Therefore, it is necessary to determine the early predictors of post-stroke infection to screen patients with high infection risk for early clinical intervention, thereby promoting and improving survival rates. We assessed 257 patients with acute ischemic stroke from a consecutive retrospective cohort. Data of these patients were obtained from three hospitals (TongJi Hospital and its two branches) between August 2018 and June 2019. Of these patients, 59 (23.0%) developed SAI. SAI was defined according to the modified Centers for Disease Control and Prevention criteria. There were 38 patients (64.4%) who developed pneumonia, 11 with urinary tract infections (18.6%), and 10 with other infections (16.9%). We found that a higher neutrophil-to-lymphocyte ratio (adjusted odds ratio [aOR] = 1.16; 95% confidence interval [CI], 1.01–1.33; P = 0.034), National Institutes of Health Stroke Scale score (aOR = 1.18; CI, 1.09–1.27; p < 0.001), and dysphagia (aOR = 2.95; CI, 1.40–6.22; P = 0.004) were risk factors for SAI. Of note, hypertriglyceridemia (aOR = 0.35; CI, 0.13–0.90; P = 0.029) was a protective factor, lowering the risk of SAI. To this end, a reliable nomogram was constructed for the prediction of SAI in our study (mean C-index value ± standard deviation = 0.821 ± 0.03). It has the potential to be widely used and may help identify patients at high risk for SAI and make timely clinical decisions. Given our study was based on relatively small dataset, the results should be interpreted with care and external validation in independent datasets is very necessary.
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spelling pubmed-76672372020-11-20 Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections Lan, Yan Sun, Wenzhe Chen, Yuxi Miao, Jinfeng Li, Guo Qiu, Xiuli Song, Xiaoyan Zhao, Xin Zhu, Zhou Fan, Yebin Zhu, Suiqiang Front Neurol Neurology Stroke has been a leading cause of mortality in China. Stroke-associated infections (SAI) are common complications, occurring in 5–65% of stroke patients. Faced with SAI, clinicians often are placed in a considerable dilemma. On the one hand, preventive overuse of antibiotics will lead to the emergence of drug-resistant bacteria. On the other hand, treatment delay of the infection will likely result in a poor outcome. Therefore, it is necessary to determine the early predictors of post-stroke infection to screen patients with high infection risk for early clinical intervention, thereby promoting and improving survival rates. We assessed 257 patients with acute ischemic stroke from a consecutive retrospective cohort. Data of these patients were obtained from three hospitals (TongJi Hospital and its two branches) between August 2018 and June 2019. Of these patients, 59 (23.0%) developed SAI. SAI was defined according to the modified Centers for Disease Control and Prevention criteria. There were 38 patients (64.4%) who developed pneumonia, 11 with urinary tract infections (18.6%), and 10 with other infections (16.9%). We found that a higher neutrophil-to-lymphocyte ratio (adjusted odds ratio [aOR] = 1.16; 95% confidence interval [CI], 1.01–1.33; P = 0.034), National Institutes of Health Stroke Scale score (aOR = 1.18; CI, 1.09–1.27; p < 0.001), and dysphagia (aOR = 2.95; CI, 1.40–6.22; P = 0.004) were risk factors for SAI. Of note, hypertriglyceridemia (aOR = 0.35; CI, 0.13–0.90; P = 0.029) was a protective factor, lowering the risk of SAI. To this end, a reliable nomogram was constructed for the prediction of SAI in our study (mean C-index value ± standard deviation = 0.821 ± 0.03). It has the potential to be widely used and may help identify patients at high risk for SAI and make timely clinical decisions. Given our study was based on relatively small dataset, the results should be interpreted with care and external validation in independent datasets is very necessary. Frontiers Media S.A. 2020-11-02 /pmc/articles/PMC7667237/ /pubmed/33224089 http://dx.doi.org/10.3389/fneur.2020.574280 Text en Copyright © 2020 Lan, Sun, Chen, Miao, Li, Qiu, Song, Zhao, Zhu, Fan and Zhu. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Lan, Yan
Sun, Wenzhe
Chen, Yuxi
Miao, Jinfeng
Li, Guo
Qiu, Xiuli
Song, Xiaoyan
Zhao, Xin
Zhu, Zhou
Fan, Yebin
Zhu, Suiqiang
Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections
title Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections
title_full Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections
title_fullStr Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections
title_full_unstemmed Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections
title_short Nomogram Including Neutrophil-to-Lymphocyte Ratio for the Prediction of Stroke-Associated Infections
title_sort nomogram including neutrophil-to-lymphocyte ratio for the prediction of stroke-associated infections
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667237/
https://www.ncbi.nlm.nih.gov/pubmed/33224089
http://dx.doi.org/10.3389/fneur.2020.574280
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