Risk factors analysis of stroke-associated pneumonia for elderly stroke patients in ICU and predictive value of monocyte HLA-DR_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SHI Yanjie , ZHENG Hui , WANG Erling , ZHENG Chunlei ,  LIU Xiaogang

Intensive Care Unit, Gaoxin District, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450000, P. R. China;

Corresponding?author：

LIU Xiaogang, Email: xiaogangliu2007@sina.com

Keywords：

Stroke; Stroke-associated pneumonia; Risk factors; Monocytes; Human leukocyte antigen

DOI：

10.7507/1671-6205.201611008

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Objective To explore risk factors of stroke-associated pneumonia (SAP) for elderly stroke patients in ICU, and analyze the predictive value of human leukocyte antigen-DR (HLA-DR) on monocytes for SAP. Methods During January 2015 to August 2016, 155 elderly patients with stroke were recruited. The level of monocyte HLA-DR expression was measured after admission and the incidence of SAP was recorded. The risk factors for SAP were analyzed by univariate and multivariate analysis. ROC curve was drawn to analyze prognostic value of HLA-DR. Results SAP occurred in 75 cases with occurrence rate of 48.4%, including 42 early-onset cases and 33 later-onset cases. Age (OR=11.532), Glasgow Coma Scale (OR=7.124), dysphagia (OR=8.846), mechanical ventilation (OR=15.184), atrial fibrillation (OR=7.869), smoking history (OR=11.784), diabetes (OR=7.185) were independent risk factors (all P<0.05). The expression rate of monocyte HLA-DR in the SAP patients was significantly lower than those in the patients without SAP (allP<0.05). Through the ROC curve analysis, the expression rate of HLA-DR that below 78.65% was the optimum cut-off value for prediction of SAP with the area under ROC curve of 0.922, the sensitivity of 80.0% and the specificity of 85.0%. The sensitivity to predict early-onset SAP was 90.5% (38/42), and to predict later-onset SAP was 66.7% (22/33). Conclusions Age, severe coma, dysphagia, mechanical ventilation, atrial fibrillation, smoking history and diabetes are risk factors for SAP in elderly stroke patients in ICU. The detection of monocyte HLA-DR has reference value for early prediction of SAP especially for early-onset SAP with higher sensitivity.

Citation： SHI Yanjie, ZHENG Hui, WANG Erling, ZHENG Chunlei, LIU Xiaogang. Risk factors analysis of stroke-associated pneumonia for elderly stroke patients in ICU and predictive value of monocyte HLA-DR. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(1): 51-54. doi: 10.7507/1671-6205.201611008 Copy

1.	鐘明媚, 王璠, 張琳, 等. 重癥監護病房卒中相關性肺炎的危險因素及病原學分析. 中華急診醫學雜志, 2015, 24(9):1004-1010.
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3.	周曙俊, 周軍, 王大明. 單核細胞人白細胞抗原 DR 監測在重癥肺炎患者預后評估中的價值. 江蘇大學學報(醫學版), 2013, 23(1):30-33.
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8.	曹艷, 龔自力, 左堯金. 老年患者腦卒中相關性肺炎的危險因素及預后分析. 中國實用神經疾病雜志, 2015, 18(22):27-28.
9.	Liu Y, Ye Q, Jin XY, et al. Etiologic diagnosis and clinical treatment of multiple drug-resistant bacteria infection in elderly patients with stroke-associated pneumonia after neurosurgery. Cell Biochem Biophys, 2015, 71(2):731-734.
10.	李遠玲, 趙紅萍, 李曉琴. 老年卒中相關性肺炎多重耐藥菌感染的危險因素分析及干預對策. 檢驗醫學與臨床, 2014, 11(5):674-675.
11.	朱剛, 余成, 鐘平, 等. 神經科重癥病房老年腦卒中相關性肺炎患者認知功能障礙發病機制. 中國老年學雜志, 2016, 36(10):2361-2363.
12.	S?rensen RT, Rasmussen RS, Overgaard K, et al. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J Neurosei Nurs, 2013, 45(3):139-146.
13.	Hannawi Y, Hannawi B, Rao CP, et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis, 2013, 35(5):430-443.
14.	Zhang H, Li X. Correlation between inflammatory factors and post-stroke pneumonia in diabetic patients. Exp Ther Med, 2013, 6(1):105-108.
15.	胡曉蕾, 堯銀光, 武蓉珍, 等. 單核細胞人類白細胞抗原 DR 預測重癥多發傷感染的臨床應用研究. 中華醫院感染學雜志, 2016, 26(11): 2456-2458.
16.	張新顏, 閆福嶺, 邵偉波, 等. 檢測單核細胞 HLA-DR 和 T 淋巴細胞亞群變化對腦卒中相關性肺炎的預測價值. 中國神經免疫學和神經病學雜志, 2013, 20(6):396-399.

1. 鐘明媚, 王璠, 張琳, 等. 重癥監護病房卒中相關性肺炎的危險因素及病原學分析. 中華急診醫學雜志, 2015, 24(9):1004-1010.
2. 顧薇, 鄧星奇, 余愛勇, 等. 卒中相關性肺炎危險因素的前瞻性研究. 中國呼吸與危重監護雜志, 2013, 12(2): 129-132.
3. 周曙俊, 周軍, 王大明. 單核細胞人白細胞抗原 DR 監測在重癥肺炎患者預后評估中的價值. 江蘇大學學報(醫學版), 2013, 23(1):30-33.
4. Wu JF, Ma J, Chen J, et al. Changes of monocyte human leukocyte antigen-DR expression as a reliable predictor of mortality in severe sepsis. Crit Care, 2011, 15(5):1-8.
5. 卒中相關性肺炎診治中國專家共識組. 卒中相關性肺炎診治中國專家共識. 中華內科雜志, 2010, 49(12):1075-1078.
6. Hiker R, Poetter C, Findeisen N, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care mendicine. Stroke, 2003,34(4):975-981.
7. 張道培, 閆福嶺, 徐海清, 等. 急性重癥腦卒中患者單核細胞 HLA-DR 的表達變化與病情及感染的關系. 中華醫院感染學雜志, 2012, 22(14):2998-3001.
8. 曹艷, 龔自力, 左堯金. 老年患者腦卒中相關性肺炎的危險因素及預后分析. 中國實用神經疾病雜志, 2015, 18(22):27-28.
9. Liu Y, Ye Q, Jin XY, et al. Etiologic diagnosis and clinical treatment of multiple drug-resistant bacteria infection in elderly patients with stroke-associated pneumonia after neurosurgery. Cell Biochem Biophys, 2015, 71(2):731-734.
10. 李遠玲, 趙紅萍, 李曉琴. 老年卒中相關性肺炎多重耐藥菌感染的危險因素分析及干預對策. 檢驗醫學與臨床, 2014, 11(5):674-675.
11. 朱剛, 余成, 鐘平, 等. 神經科重癥病房老年腦卒中相關性肺炎患者認知功能障礙發病機制. 中國老年學雜志, 2016, 36(10):2361-2363.
12. S?rensen RT, Rasmussen RS, Overgaard K, et al. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J Neurosei Nurs, 2013, 45(3):139-146.
13. Hannawi Y, Hannawi B, Rao CP, et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis, 2013, 35(5):430-443.
14. Zhang H, Li X. Correlation between inflammatory factors and post-stroke pneumonia in diabetic patients. Exp Ther Med, 2013, 6(1):105-108.
15. 胡曉蕾, 堯銀光, 武蓉珍, 等. 單核細胞人類白細胞抗原 DR 預測重癥多發傷感染的臨床應用研究. 中華醫院感染學雜志, 2016, 26(11): 2456-2458.
16. 張新顏, 閆福嶺, 邵偉波, 等. 檢測單核細胞 HLA-DR 和 T 淋巴細胞亞群變化對腦卒中相關性肺炎的預測價值. 中國神經免疫學和神經病學雜志, 2013, 20(6):396-399.

Chinese Journal of Respiratory and Critical Care Medicine

Risk factors analysis of stroke-associated pneumonia for elderly stroke patients in ICU and predictive value of monocyte HLA-DR

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