Neuropsychiatric Disease and Treatment (Oct 2020)
Value of Combination of the A2DS2 Score and IL-6 in Predicting Stroke-Associated Pneumonia
Abstract
Jun Yang,1 Yonghong Dai,1 Zuowen Zhang,2 Yue Chen3 1Department of Critical Care Medicine, Central Hospital of Jiangjin District, Chongqing 402260, People’s Republic of China; 2Department of Neurology, Central Hospital of Jiangjin District, Chongqing 402260, People’s Republic of China; 3Department of Rehabilitation, Central Hospital of Jiangjin District, Chongqing 402260, People’s Republic of ChinaCorrespondence: Yue ChenDepartment of Rehabilitation, Central Hospital of Jiangjin District, Chongqing Dingshan Street, Jiangjin District, Chongqing 402260, People’s Republic of ChinaTel +86-15823491696Email [email protected]: To evaluate the value of the combination of the age, atrial fibrillation, dysphagia, male sex, and National Institutes of Health Stroke Scale (A2DS2) 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 A2DS2 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 A2DS2 score, serum IL-6 concentration and combination of A2DS2 score and IL-6 in predicting SAP.Results: SAP was diagnosed in 70 patients (17.6%). Multivariate analysis showed that the A2DS2 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 A2DS2 score, serum IL-6 concentration and combination of A2DS2 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 A2DS2 score could significantly enhance the AUC of predicting SAP in AIS patients from the medical ward.Keywords: stroke-associated pneumonia; SAP, A2DS2 score, interleukin 6, multivariate analysis, receiver operating characteristic curve; ROC
