Abstract：
It is not known whether modern stroke unit care reduces the impact of stroke complications, such as stroke-associated pneumonia (SAP), on clinical outcomes. We investigated the relationship between SAP and clinical outcomes, adjusting for the confounding effects of stroke care processes and their timing.
The Sentinel Stroke National Audit Programme provided patient data for all confirmed strokes between April 2013 and December 2018. SAP was defined as new antibiotic initiation for suspected pneumonia within the first 7 days from stroke admission. We compared outcomes after SAP versus non-SAP in appropriate multilevel mixed models. Each model was adjusted for patient and clinical characteristics, as well as markers of stroke care and their timing within the first 72 h. The appropriate effect estimates and corresponding 95% confidence intervals (CIs) were reported.
Of 201,778 patients, SAP was present in 14.2%. After adjustment for timing of acute stroke care processes and clinical characteristics, adverse outcomes remained for SAP versus non-SAP patients. In these adjusted analyses, patients with SAP maintained an increased risk of longer length of in-hospital stay (IRR of 1.27; 95% CI: 1.25, 1.30), increased odds of worse functional outcome at discharge (OR of 2.9; 95% CI: 2.9, 3.0), and increased risk of in-hospital mortality (HR of 1.78; 95% CI: 1.74, 1.82).
We show for the first time that SAP remains associated with worse clinical outcomes, even after adjusting for processes of acute stroke care and their timing. These findings highlight the importance of continued research efforts aimed at preventing SAP.
The Sentinel Stroke National Audit Programme provided patient data for all confirmed strokes between April 2013 and December 2018. SAP was defined as new antibiotic initiation for suspected pneumonia within the first 7 days from stroke admission. We compared outcomes after SAP versus non-SAP in appropriate multilevel mixed models. Each model was adjusted for patient and clinical characteristics, as well as markers of stroke care and their timing within the first 72 h. The appropriate effect estimates and corresponding 95% confidence intervals (CIs) were reported.
Of 201,778 patients, SAP was present in 14.2%. After adjustment for timing of acute stroke care processes and clinical characteristics, adverse outcomes remained for SAP versus non-SAP patients. In these adjusted analyses, patients with SAP maintained an increased risk of longer length of in-hospital stay (IRR of 1.27; 95% CI: 1.25, 1.30), increased odds of worse functional outcome at discharge (OR of 2.9; 95% CI: 2.9, 3.0), and increased risk of in-hospital mortality (HR of 1.78; 95% CI: 1.74, 1.82).
We show for the first time that SAP remains associated with worse clinical outcomes, even after adjusting for processes of acute stroke care and their timing. These findings highlight the importance of continued research efforts aimed at preventing SAP.
摘要：
背景：尚不清楚现代卒中单元护理是否减少了卒中并发症的影响，例如卒中相关性肺炎（SAP），关于临床结果。我们调查了SAP与临床结果之间的关系，调整中风护理过程及其时机的混杂效应。
方法：前哨卒中国家审计计划提供了2013年4月至2018年12月期间所有确诊卒中的患者数据。SAP被定义为在卒中入院后的前7天内开始使用新的抗生素治疗疑似肺炎。我们在适当的多水平混合模型中比较了SAP与非SAP后的结果。每个模型都根据患者和临床特征进行了调整，以及卒中治疗的标志物及其在前72小时内的时间安排。报告了适当的效果估计和相应的95％置信区间（CI）。
结果：在201,778名患者中，SAP占14.2%。在调整了急性中风护理流程和临床特征的时机后，与非SAP患者相比,SAP患者的不良结局仍然存在.在这些调整后的分析中，SAP患者住院时间延长的风险增加(IRR为1.27;95%CI:1.25,1.30),出院时功能结局恶化的几率增加(OR为2.9；95%CI：2.9，3.0)，住院死亡率风险增加（HR为1.78；95%CI：1.74，1.82）。
结论：我们首次表明SAP仍然与较差的临床结果相关，即使在调整了急性中风护理的过程及其时机之后。这些发现强调了持续研究旨在预防SAP的重要性。
方法：前哨卒中国家审计计划提供了2013年4月至2018年12月期间所有确诊卒中的患者数据。SAP被定义为在卒中入院后的前7天内开始使用新的抗生素治疗疑似肺炎。我们在适当的多水平混合模型中比较了SAP与非SAP后的结果。每个模型都根据患者和临床特征进行了调整，以及卒中治疗的标志物及其在前72小时内的时间安排。报告了适当的效果估计和相应的95％置信区间（CI）。
结果：在201,778名患者中，SAP占14.2%。在调整了急性中风护理流程和临床特征的时机后，与非SAP患者相比,SAP患者的不良结局仍然存在.在这些调整后的分析中，SAP患者住院时间延长的风险增加(IRR为1.27;95%CI:1.25,1.30),出院时功能结局恶化的几率增加(OR为2.9；95%CI：2.9，3.0)，住院死亡率风险增加（HR为1.78；95%CI：1.74，1.82）。
结论：我们首次表明SAP仍然与较差的临床结果相关，即使在调整了急性中风护理的过程及其时机之后。这些发现强调了持续研究旨在预防SAP的重要性。
