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Outcome and Risk of Poststroke Pneumonia in Patients with Acute Ischemic Stroke After Endovascular Thrombectomy: A Post Hoc Analysis of the DIRECT-MT Trial

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Abstract

Background

In this study, we aimed to investigate the risk factors and impact of poststroke pneumonia (PSP) on mortality and functional outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT).

Methods

This was a post hoc analysis of a prospective randomized trial (Direct intraarterial thrombectomy in order to revascularize AIS patients with large-vessel occlusion efficiently in Chinese tertiary hospitals: a multicenter randomized clinical trial). Patients with AIS who completed EVT were evaluated for the occurrence of PSP during the hospitalization period and their modified Rankin Scale (mRS) scores at 90 days after AIS. Logistic regression analysis was conducted to investigate the independent predictors of PSP. Propensity score matching was conducted for the PSP and non-PSP groups by using the covariates resulting from the logistic regression analysis. The associations between PSP and outcomes were analyzed. The outcomes included 90-day poor functional outcome (mRS scores > 2), 90-day mortality, and early 2-week mortality.

Results

A total of 639 patients were enrolled, of whom 29.58% (189) developed PSP. Logistic regression analysis revealed that history of chronic heart failure (unadjusted odds ratio [OR] 2.011, 95% confidence interval [CI] 1.026–3.941; P = 0.042), prethrombectomy reperfusion on initial digital subtraction angiography (OR 0.394, 95% CI 0.161–0.964; P = 0.041), creatinine levels at admission (OR 1.008, 95% CI 1.000–1.016; P = 0.049), and National Institutes of Health Stroke Scale at 24 h (OR 1.023, 95% CI 1.007–1.039; P = 0.004) were independent risk factors for PSP. With propensity scoring matching, poor functional outcome (mRS > 2) was more common in patients with PSP than in patients without PSP (81.03% vs. 71.83%, P = 0.043) at 90 days after EVT. The early 2-week mortality of patients with PSP was lower (5.74% vs. 12.07%, P = 0.038). But there was no statistically significant difference in 90-day mortality between the PSP group and non-PSP group (22.41% vs. 14.94%, P = 0.074). The survivorship curve also shows no statistical significance (P = 0.088) between the two groups.

Conclusions

Nearly one third of patients with AIS and EVT developed PSP. Heart failure, higher creatinine levels, prethrombectomy reperfusion, and National Institutes of Health Stroke Scale at 24 h were associated with PSP in these patients. PSP was associated with poor 90-day functional outcomes in patients with AIS treated with EVT.

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Funding

This work was funded by a grant (GN-2017R0001) from the Stroke Prevention Project of the National Health Commission of the People’s Republic of China and by the Wu Jieping Medical Foundation.

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Author notes

  1. Ping Zhang and Lei Chen are co-first authors.

Authors and Affiliations

  1. Department of Neurovascular Center, Naval Medical University Changhai Hospital, 168 Changhai Rd., Shanghai, 200433, China

    Ping Zhang, Lei Chen, Tao Wu, Ben-qiang Deng, Peng-fei Yang, Yong-wei Zhang & Jian-min Liu

  2. Department of Neurology, Naval Medical Center of the Chinese People’s Liberation Army (PLA), Naval Medical University, Shanghai, China

    Ping Zhang & Yi Han

  3. Department of Statistics, Naval Medical University, Shanghai, China

    Xiao-fei Ye

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  1. Ping Zhang
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Contributions

PZ conducted research design and writing. Lei Chen was responsible for the data collection. XFY was responsible for statistical analysis. Writing direction was given by TW and BQD. YH revised the article. PFY and YWZ conducted the Direct intraarterial thrombectomy in order to revascularize AIS patients with large-vessel occlusion efficiently in Chinese tertiary hospitals: a multicenter randomized clinical trial. JML was the organizer of the Direct intraarterial thrombectomy in order to revascularize AIS patients with large-vessel occlusion efficiently in Chinese tertiary hospitals: a multicenter randomized clinical trial. The final manuscript was approved by all authors.

Corresponding author

Correspondence to Yong-wei Zhang.

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Ethical Approval/Informed Consent

The study was approved by the institutional review board and local ethical committee of the 41 academic tertiary care centers concerned. The main ethical approval number is CHEC2018-003 by Shanghai Changhai Hospital Ethics Committee.

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The authors of this article declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Zhang, P., Chen, L., Ye, Xf. et al. Outcome and Risk of Poststroke Pneumonia in Patients with Acute Ischemic Stroke After Endovascular Thrombectomy: A Post Hoc Analysis of the DIRECT-MT Trial. Neurocrit Care (2024). https://doi.org/10.1007/s12028-024-01947-x

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