Time to develop aspiration pneumonia and its predictors among stroke patients admitted at specialized hospitals in Western Amhara during the armed conflict period, 2024

Abstract

Abstract Stroke, characterized by a sudden neurologic deficit due to reduced cerebral perfusion, often leads to complications such as aspiration pneumonia. This acute lung infection occurs when substances from the gastrointestinal tract, including endogenous flora, enter the respiratory system. Despite advancements in care, pneumonia remains a common complication in stroke patients, contributing significantly to increased morbidity and mortality. To determine the time to develop aspiration pneumonia and identify its predictors among stroke patients admitted to specialized hospitals in Western Amhara during the armed conflict period, 2024. A retrospective follow-up study was conducted on 814 adult stroke patients admitted to specialized hospitals in Western Amhara from June 1, 2014, to August 30, 2024. Data were extracted from patient charts, entered into EpiData version 4.2, and analyzed using STATA version 17. The Kaplan–Meier method and Cox proportional hazards regression model were employed to estimate the time to aspiration pneumonia and identify its predictors. Survival probabilities were assessed using Kaplan–Meier curves, with the log-rank test used to compare groups. Adjusted hazard ratios (AHR) with 95% confidence intervals were calculated, and variables with a p-value ≤ 0.05 in the multivariable analysis were considered statistically significant. The incidence rate ratio of aspiration pneumonia was 12.66 per 100 person-days, and the median survival time was 7 days. Stroke patients with comorbidities were 3.58 times more likely to develop aspiration pneumonia compared to those without comorbidities (AHR = 3.58; 95% CI 1.25–10.22). Similarly, stroke patients who did not receive IV fluid therapy developed aspiration pneumonia 65% faster than those who received it (AHR = 0.35; 95% CI 0.14–0.91). Furthermore, stroke patients with hospital stays of ten or more days developed aspiration pneumonia 88% faster than those with shorter hospital stays (AHR = 0.12; 95% CI 0.06–0.19). This study highlights the significant burden of aspiration pneumonia in stroke patients. Key risk factors include comorbid conditions, prolonged hospital stays, and inadequate IV fluid therapy. Early detection, effective fluid management, infection control, and educating caregivers on prevention are essential strategies to reduce aspiration pneumonia, minimize complications, and improve recovery.

Keywords

• Stroke
• Treatment outcome
• Aspiration pneumonia
• Poor treatment outcome