Accuracy of different screening tools for ischemic stroke-associated pneumonia: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CHENG Linwen ¹ , ZHENG Lei ¹ , TAN Jianhua ² , FANG Leyi ¹ , XIA Yunhui ¹ , CAI Tingting ¹ , MO Hangfeng ¹ , SHI Yin ³ ,  SHEN Jiantong ¹

1. Department of Huzhou University School of Nursing Science, Huzhou 313000, P. R. China;
2. Wuxing District People’s Hospital of Huzhou city, Huzhou 313000, P. R. China;
3. Department of Critical Care Medicine, Deqing Couty People’s Hospital, Huzhou 313200, P. R. China;

Corresponding?author：

SHEN Jiantong, Email: sjiantong@163.com

Keywords：

Stroke; Stroke-associated pneumonia; Screening tools; Accuracy; Network meta-analysis

DOI：

10.7507/1672-2531.202410002

Video：

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Objective To systematically review the accuracy of different stroke-associated pneumonia (SAP) assessment tools. Methods The PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, WanFang Data, and CBM databases were electronically searched to collect studies related to the objectives from inception to January 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A network meta-analysis was then performed by using Meta-disc 1.4 and Stata 17.0 software. Results A total of 20 studies were included, involving 6 SAP assessment tools. The results of network meta-analysis showed that the sensitivity of AIS-APS was higher than that of A2DS2, and the specificity of A2DS2 was higher than that of PANTHERIS, and the difference was statistically significant. The sensitivity SUCRA values from high to low were: AIS-APS (95.6%) > PANTHERIS (46.7%) > Kwon (44.1%) > A2DS2 (40.5%) > Chumbler (37.3%) > ISAN (35.8%). The specificity SUCRA values from high to low were: A2DS2 (84.0%) > Chumbler (66.0%) > ISAN (59.5%) > AIS-APS (41.4%) > Kwon (37.0%) > PANTHERIS (12.1%) Conclusion Among the common stroke-associated pneumonia screening tools used to screen patients with ischemic stroke, AIS-APS has the highest sensitivity and A2DS2 has the highest specificity.

Citation： CHENG Linwen, ZHENG Lei, TAN Jianhua, FANG Leyi, XIA Yunhui, CAI Tingting, MO Hangfeng, SHI Yin, SHEN Jiantong. Accuracy of different screening tools for ischemic stroke-associated pneumonia: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2025, 25(9): 1020-1024. doi: 10.7507/1672-2531.202410002 Copy

1.	Finlayson O, Kapral M, Hall R, et al. Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology, 2011, 77(14): 1338-1345.
2.	Li J, Zhang P, Wu S, et al. Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome. Ther Adv Neurol Disord, 2019, 12: 1756286419873264.
3.	王擁軍, 陳玉國, 呂傳柱, 等. 卒中相關性肺炎診治中國專家共識(2019更新版). 中國卒中雜志, 2019, 14(12): 1251-1262.
4.	Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand, 2018, 138(4): 293-300.
5.	Smith CJ, Bray BD, Hoffman A, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care. A UK multicenter cohort study. J Am Heart Assoc, 2015, 4(1): e001307.
6.	Yu YJ, Weng WC, Su FC, et al. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke. J Clin Neurosci, 2016, 33: 124-128.
7.	Katzan IL, Cebul RD, Husak SH, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology, 2003, 60(4): 620-625.
8.	Ali AN, Howe J, Majid A, et al. The economic cost of stroke-associated pneumonia in a UK setting. Top Stroke Rehabil, 2018, 25(3): 214-223.
9.	Lobo Chaves MA, Gittins M, Bray B, et al. Do stroke care processes modify clinical outcomes in patients with stroke-associated pneumonia. A registry cohort study in England and Wales. Cerebrovasc Dis, 2023, 52(1): 21-27.
10.	Elkind MSV, Boehme AK, Smith CJ, et al. Infection as a stroke risk factor and determinant of outcome after stroke. Stroke, 2020, 51(10): 3156-3168.
11.	Nam KW, Kim TJ, Lee JS, et al. High neutrophil-to-lymphocyte ratio predicts stroke-associated pneumonia. Stroke, 2018, 49(8): 1886-1892.
12.	Badve MS, Zhou Z, van de Beek D, et al. Frequency of post-stroke pneumonia: systematic review and meta-analysis of observational studies. Int J Stroke, 2019, 14(2): 125-136.
13.	張秀梅, 丑曉華, 馬翠. 急性腦梗死患者卒中相關性肺炎的危險因素與抗感染治療的耐藥性分析. 抗感染藥學, 2019, 16(12): 2046-2051.
14.	Helmy TA, Abd-Elhady MA, Abdou M. Prediction of ischemic stroke-associated pneumonia: a comparison between 3 scores. J Stroke Cerebrovasc Dis, 2016, 25(11): 2756-2761.
15.	張國倩. 淋巴細胞單核細胞比值聯合A~2DS~2評分對卒中相關性肺炎的預測價值. 天津: 天津醫科大學, 2019.
16.	韓蕾, 劉勇, 張秋霞. A2DS2和AIS-APS量表對老年腦卒中相關性肺炎的預測意義. 中華肺部疾病雜志(電子版), 2021, 14(3): 335-337.
17.	Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies. Ann Intern Med, 2021, 174(11): 1592-1599.
18.	黃玉香, 沈建通, 劉雨今. 診斷試驗準確性比較研究偏倚風險評價工具QUADAS-C解讀. 中國循證醫學雜志, 2022, 22(9): 1108-1116.
19.	Zapata-Arriaza E, Moniche F, Blanca PG, et al. External validation of the ISAN, A2DS2, and AIS-APS scores for predicting stroke-associated pneumonia. J Stroke Cerebrovasc Dis, 2018, 27(3): 673-676.
20.	Gong S, Zhou Z, Zhou M, et al. Validation of risk scoring models for predicting stroke-associated pneumonia in patients with ischaemic stroke. Stroke Vasc Neurol, 2016, 1(3): 122-126.
21.	杭景, 潘希丁, 戈念念, 等. 缺血性卒中患者卒中相關性肺炎的預測: 6種評分的比較. 國際腦血管病雜志, 2017, 25(11): 972-978.
22.	羅小娜, 劉新生, 王昆, 等. 兩種量表對急性缺血性腦卒中相關性肺炎預測價值的比較. 中華老年心腦血管病雜志, 2018, 20(11): 1183-1186.
23.	苑藝. 西寧地區急性缺血性卒中相關性肺炎的危險因素及ISAN、A2DS2評分預測價值研究. 西寧: 青海大學, 2018.
24.	張亞蓬, 楊愛明. A2DS2評分與AIS-APS評分在預測卒中相關肺炎中的表現. 心肺血管病雜志, 2019, 38(6): 624-628.
25.	王功碩, 史家欣, 張廣慧, 等. 不同評分量表在預測卒中相關性肺炎中的價值比較. 中國醫師進修雜志, 2022, 45(11): 984-991.
26.	Ji R, Shen H, Pan Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke, 2013, 44(5): 1303-1309.
27.	焦嬌. 卒中相關肺炎的臨床預測評分效能評價及細菌流行病學和耐藥性調查. 南京: 東南大學, 2019.
28.	Cugy E, Sibon I. Stroke-associated pneumonia risk score: validity in a French stroke unit. J Stroke Cerebrovasc Dis, 2017, 26(1): 225-229.
29.	單曄, 陳冬勤. 不同卒中相關性肺炎預測量表在缺血性腦卒中患者中預測作用的比較. 護理學報, 2018, 25(24): 43-46.
30.	李芳, 徐麗華, 冀瑞俊, 等. 急性缺血性卒中相關肺炎評分臨床應用價值分析. 中國卒中雜志, 2020, 15(11): 1204-1209.
31.	王娜, 劉蘆姍, 王豐容. 四種評分系統對缺血性腦卒中相關性肺炎的預測價值比較. 中國康復理論與實踐, 2018, 24(6): 696-701.
32.	楊銳, 李皓, 王曉鵬, 等. A2DS2與AIS-APS評分預測卒中相關肺炎準確性的比較. 當代醫學, 2019, 25(9): 164-166.
33.	張銳, 黃榮, 譚登云, 等. 卒中相關性肺炎影響因素的模型構建及其與3種預測評分系統的比較. 中華醫院感染學雜志, 2022, 32(18): 2767-2771.
34.	孫怡瑋. 腦梗死患者卒中相關性肺炎的危險預測因素研究. 上海: 同濟大學, 2019.
35.	Ramírez-Moreno JM, Martínez-Acevedo M, Cordova R, et al. External validation of the A2SD2 and ISAN scales for predicting infectious respiratory complications of ischaemic stroke. Neurologia (Engl Ed), 2019, 34(1): 14-21.
36.	Elhasin H, Szolics M, Hassan A, et al. Risk scores for predicting stroke associated pneumonia: validity of A2DS2 and ISAN scores. J Neurol Sci, 2019, 405: 41-42.
37.	杜慶霞, 丁寧, 李維軼, 等. AIS-APS評分在預測急性缺血性卒中相關性肺炎中的應用價值研究. 中華急診醫學雜志, 2016, 25(10): 1268-1271.
38.	Harms H, Hoffmann S, Malzahn U, et al. Decision-making in the diagnosis and treatment of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry, 2012, 83(12): 1225-1230.
39.	Huang J, Liu M, He W, et al. Use of the A2DS2 scale to predict morbidity in stroke-associated pneumonia: a systematic review and meta-analysis. BMC Neurol, 2021, 21(1): 33.
40.	Zhang X, Yu S, Wei L, et al. The A2DS2 score as a predictor of pneumonia and in-hospital death after acute ischemic stroke in Chinese populations. PLoS One, 2016, 11(3): e0150298.

1. Finlayson O, Kapral M, Hall R, et al. Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology, 2011, 77(14): 1338-1345.
2. Li J, Zhang P, Wu S, et al. Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome. Ther Adv Neurol Disord, 2019, 12: 1756286419873264.
3. 王擁軍, 陳玉國, 呂傳柱, 等. 卒中相關性肺炎診治中國專家共識(2019更新版). 中國卒中雜志, 2019, 14(12): 1251-1262.
4. Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand, 2018, 138(4): 293-300.
5. Smith CJ, Bray BD, Hoffman A, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care. A UK multicenter cohort study. J Am Heart Assoc, 2015, 4(1): e001307.
6. Yu YJ, Weng WC, Su FC, et al. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke. J Clin Neurosci, 2016, 33: 124-128.
7. Katzan IL, Cebul RD, Husak SH, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology, 2003, 60(4): 620-625.
8. Ali AN, Howe J, Majid A, et al. The economic cost of stroke-associated pneumonia in a UK setting. Top Stroke Rehabil, 2018, 25(3): 214-223.
9. Lobo Chaves MA, Gittins M, Bray B, et al. Do stroke care processes modify clinical outcomes in patients with stroke-associated pneumonia. A registry cohort study in England and Wales. Cerebrovasc Dis, 2023, 52(1): 21-27.
10. Elkind MSV, Boehme AK, Smith CJ, et al. Infection as a stroke risk factor and determinant of outcome after stroke. Stroke, 2020, 51(10): 3156-3168.
11. Nam KW, Kim TJ, Lee JS, et al. High neutrophil-to-lymphocyte ratio predicts stroke-associated pneumonia. Stroke, 2018, 49(8): 1886-1892.
12. Badve MS, Zhou Z, van de Beek D, et al. Frequency of post-stroke pneumonia: systematic review and meta-analysis of observational studies. Int J Stroke, 2019, 14(2): 125-136.
13. 張秀梅, 丑曉華, 馬翠. 急性腦梗死患者卒中相關性肺炎的危險因素與抗感染治療的耐藥性分析. 抗感染藥學, 2019, 16(12): 2046-2051.
14. Helmy TA, Abd-Elhady MA, Abdou M. Prediction of ischemic stroke-associated pneumonia: a comparison between 3 scores. J Stroke Cerebrovasc Dis, 2016, 25(11): 2756-2761.
15. 張國倩. 淋巴細胞單核細胞比值聯合A~2DS~2評分對卒中相關性肺炎的預測價值. 天津: 天津醫科大學, 2019.
16. 韓蕾, 劉勇, 張秋霞. A2DS2和AIS-APS量表對老年腦卒中相關性肺炎的預測意義. 中華肺部疾病雜志(電子版), 2021, 14(3): 335-337.
17. Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies. Ann Intern Med, 2021, 174(11): 1592-1599.
18. 黃玉香, 沈建通, 劉雨今. 診斷試驗準確性比較研究偏倚風險評價工具QUADAS-C解讀. 中國循證醫學雜志, 2022, 22(9): 1108-1116.
19. Zapata-Arriaza E, Moniche F, Blanca PG, et al. External validation of the ISAN, A2DS2, and AIS-APS scores for predicting stroke-associated pneumonia. J Stroke Cerebrovasc Dis, 2018, 27(3): 673-676.
20. Gong S, Zhou Z, Zhou M, et al. Validation of risk scoring models for predicting stroke-associated pneumonia in patients with ischaemic stroke. Stroke Vasc Neurol, 2016, 1(3): 122-126.
21. 杭景, 潘希丁, 戈念念, 等. 缺血性卒中患者卒中相關性肺炎的預測: 6種評分的比較. 國際腦血管病雜志, 2017, 25(11): 972-978.
22. 羅小娜, 劉新生, 王昆, 等. 兩種量表對急性缺血性腦卒中相關性肺炎預測價值的比較. 中華老年心腦血管病雜志, 2018, 20(11): 1183-1186.
23. 苑藝. 西寧地區急性缺血性卒中相關性肺炎的危險因素及ISAN、A2DS2評分預測價值研究. 西寧: 青海大學, 2018.
24. 張亞蓬, 楊愛明. A2DS2評分與AIS-APS評分在預測卒中相關肺炎中的表現. 心肺血管病雜志, 2019, 38(6): 624-628.
25. 王功碩, 史家欣, 張廣慧, 等. 不同評分量表在預測卒中相關性肺炎中的價值比較. 中國醫師進修雜志, 2022, 45(11): 984-991.
26. Ji R, Shen H, Pan Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke, 2013, 44(5): 1303-1309.
27. 焦嬌. 卒中相關肺炎的臨床預測評分效能評價及細菌流行病學和耐藥性調查. 南京: 東南大學, 2019.
28. Cugy E, Sibon I. Stroke-associated pneumonia risk score: validity in a French stroke unit. J Stroke Cerebrovasc Dis, 2017, 26(1): 225-229.
29. 單曄, 陳冬勤. 不同卒中相關性肺炎預測量表在缺血性腦卒中患者中預測作用的比較. 護理學報, 2018, 25(24): 43-46.
30. 李芳, 徐麗華, 冀瑞俊, 等. 急性缺血性卒中相關肺炎評分臨床應用價值分析. 中國卒中雜志, 2020, 15(11): 1204-1209.
31. 王娜, 劉蘆姍, 王豐容. 四種評分系統對缺血性腦卒中相關性肺炎的預測價值比較. 中國康復理論與實踐, 2018, 24(6): 696-701.
32. 楊銳, 李皓, 王曉鵬, 等. A2DS2與AIS-APS評分預測卒中相關肺炎準確性的比較. 當代醫學, 2019, 25(9): 164-166.
33. 張銳, 黃榮, 譚登云, 等. 卒中相關性肺炎影響因素的模型構建及其與3種預測評分系統的比較. 中華醫院感染學雜志, 2022, 32(18): 2767-2771.
34. 孫怡瑋. 腦梗死患者卒中相關性肺炎的危險預測因素研究. 上海: 同濟大學, 2019.
35. Ramírez-Moreno JM, Martínez-Acevedo M, Cordova R, et al. External validation of the A2SD2 and ISAN scales for predicting infectious respiratory complications of ischaemic stroke. Neurologia (Engl Ed), 2019, 34(1): 14-21.
36. Elhasin H, Szolics M, Hassan A, et al. Risk scores for predicting stroke associated pneumonia: validity of A2DS2 and ISAN scores. J Neurol Sci, 2019, 405: 41-42.
37. 杜慶霞, 丁寧, 李維軼, 等. AIS-APS評分在預測急性缺血性卒中相關性肺炎中的應用價值研究. 中華急診醫學雜志, 2016, 25(10): 1268-1271.
38. Harms H, Hoffmann S, Malzahn U, et al. Decision-making in the diagnosis and treatment of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry, 2012, 83(12): 1225-1230.
39. Huang J, Liu M, He W, et al. Use of the A2DS2 scale to predict morbidity in stroke-associated pneumonia: a systematic review and meta-analysis. BMC Neurol, 2021, 21(1): 33.
40. Zhang X, Yu S, Wei L, et al. The A2DS2 score as a predictor of pneumonia and in-hospital death after acute ischemic stroke in Chinese populations. PLoS One, 2016, 11(3): e0150298.

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