Pneumonia after Hemorrhagic Stroke: Incidence, Risk Factors, and Outcomes

Objective: Pneumonia is one of the most common medical complications after stroke, with an estimated incidence ranging from 5% to 26%. Pneumonia increases the risk of death by approximately 3 times that of patients who do not contract pneumonia, and it has the highest attributable mortality of all medical complications after stroke. Clinical studies have identified the risk factors for pneumonia in patients with ischemic stroke. We undertook this study to retrospectively evaluate the incidence, risk factors, and outcomes of hospital-acquired bacterial pneumonia in a group of patients with hemorrhagic stroke. Methods: This was a retrospective review of consecutive adult patients admitted to the neurosurgical intensive care unit (ICU) in our hospital because of hemorrhagic stroke between January 2008 and December 2010. Results: During the study period, 466 patients were admitted to the ICU. Multivariable Cox regression analysis showed that Glasgow Coma Scale (GCS) score (hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.89-0.99), nasogastric tube (NG tube) insertion (HR 7.61; 95% CI 2.26-25.59), and the length of ICU stay (HR 1.05; 95% CI 1.04-1.07) were significantly associated with the development of pneumonia. Conclusions: Our study identified 3 risk factors for pneumonia in hemorrhagic stroke patients; GCS score (cutoff point, 12; sensitivity 76.5%; specificity 55.8%), NG tube insertion, and the length of ICU stay (cutoff point, 10 days; sensitivity 84.3%; specificity 90.1%). These risk factors constitute the basis of a simple screening tool used to evaluate the risk of pneumonia.