A nomogram based on nutritional status and A(2)DS(2) score for predicting stroke-associated pneumonia in acute ischemic stroke patients with type 2 diabetes mellitus: A retrospective study

作者全名："Song, Xiaodong; He, Yang; Bai, Jie; Zhang, Jun"

作者地址："[Song, Xiaodong; He, Yang; Zhang, Jun] Peking Univ Peoples Hosp, Dept Neurol, Beijing, Peoples R China; [Bai, Jie] Chongqing Med Univ, Dept Infect Dis, Affiliated Hosp 1, Chongqing, Peoples R China"

通信作者："Zhang, J (通讯作者)，Peking Univ Peoples Hosp, Dept Neurol, Beijing, Peoples R China.; Bai, J (通讯作者)，Chongqing Med Univ, Dept Infect Dis, Affiliated Hosp 1, Chongqing, Peoples R China."

来源：FRONTIERS IN NUTRITION

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000875823000001

JCR分区：Q2

影响因子：5

年份：2022

卷号：9

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：stroke-associated pneumonia; nutritional status; A(2)DS(2) score; acute ischemic stroke; type 2 diabetes mellitus

摘要："BackgroundStroke-associated pneumonia (SAP) commonly complicates acute ischemic stroke (AIS) and significantly worsens outcomes. Type 2 diabetes mellitus (T2DM) may contribute to malnutrition, impair innate immunity function, and increase the probability of SAP occurrence in AIS patients. We aimed to determine early predictors of SAP in AIS patients with T2DM and to construct a nomogram specifically for predicting SAP in this population by combining the A(2)DS(2) score with available nutrition-related parameters. MethodsA total of 1,330 consecutive AIS patients with T2DM were retrospectively recruited. The patients were randomly allocated to the training (n = 887) and validation groups (n = 443). Univariate and multivariate binary logistic regression analyses were applied to determine the predictors of SAP in the training group. A nomogram was established according to the identified predictors. The areas under the receiver operating characteristic curve (AUROC) and calibration plots were performed to access the predictive values of the nomogram. The decision curve was applied to evaluate the net benefits of the nomogram. ResultsThe incidence of SAP was 9% and 9.7% in the training and validation groups, respectively. The results revealed that the A(2)DS(2) score, stroke classification, Geriatric Nutritional Risk Index, hemoglobin, and fast blood glucose were independent predictors for SAP. A novel nomogram, A(2)DS(2)-Nutrition, was constructed based on these five predictors. The AUROC for A(2)DS(2)-Nutrition (0.820, 95% CI: 0.794-0.845) was higher than the A(2)DS(2) score (0.691, 95% CI: 0.660-0.722) in the training group. Similarly, it showed a better predictive performance than the A(2)DS(2) score [AUROC = 0.864 (95% CI: 0.828-0.894) vs. AUROC = 0.763 (95% CI: 0.720-0.801)] in the validation group. These results were well calibrated in the two groups. Moreover, the decision curve revealed that the A(2)DS(2)-Nutrition provided an additional net benefit to the AIS patients with T2DM compared to the A(2)DS(2) score in both groups. ConclusionThe A(2)DS(2) score, stroke classification, Geriatric Nutritional Risk Index, hemoglobin, and fast blood glucose were independent predictors for SAP in AIS patients with T2DM. Thus, the proposed A(2)DS(2)-Nutrition may be a simple and reliable prediction model for SAP occurrence in AIS patients with T2DM."

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