(614) Pneumonia After Acute Ischemic Stroke in a Neurocritical Care Unit

Introduction: Pneumonia (PNA) after acute ischemic stroke (AIS) has been linked to increased mortality and morbidity. Stroke etiology can be categorized into five categories, namely, large artery atherosclerosis, cardioembolism, small vessel occlusion, stroke of other determined etiology and stroke of undetermined etiology. The goal of this study is to evaluate PNA risk in AIS patients based on stroke etiology.

Methods: Patients admitted to Baylor St. Luke’s Medical Center Neurocritical Care Unit with AIS from October 2018 to August 2020 were retrospectively studied. PNA was defined as a combination of clinical findings (temperature>100.4F, leukocytosis >10,500 cells/µL, positive sputum culture, increased or new onset secretions) with or without chest x-ray findings in patients without other obvious sources of infection. Chi-squared test and ANOVA were performed.

Results: A total of 284 patients were studied. The PNA incidence was 9.3%.There was no PNA reported in strokes due to small vessel occlusion or other determined etiology. PNA was not associated with higher mortality (90% survival rate in PNA patients versus 93% survival rate in patients without pneumonia; p-value = 0.44) in AIS patients . However, PNA was associated with higher mean ICU length of stay in AIS patients (3.9 days vs 9.8 days; p-value < 0.001). ANOVA results showed a statistically significant difference in stroke etiology and PNA incidence (p-value = 0.005 ) with higher rates of PNA in patients with large artery atherosclerosis when compared to patients with stroke of undetermined etiology (18 % vs 3%; p-value = 0.038 ). There was no difference in PNA rates between cardioembolic strokes patients and patients with stroke of undetermined etiology (11% vs 3%; p-value = 0.48)

Conclusions: In our dataset, AIS had a high risk of PNA, particularly when the etiology is large artery atherosclerosis. While PNA did not impact in-hospital mortality in AIS patients, PNA increased the length of ICU stay. Early identification and timely intervention in at-risk patients may minimize health care costs and improve functional outcomes. Analysis of PNA risk factors such as the stroke location, and the resultant deficits would be beneficial. Additionally, investigating targeted protocols such as oral hygiene and post pyloric feeding may be warranted.