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.	钟明媚, 王璠, 张琳, 等. 重症监护病房卒中相关性肺炎的危险因素及病原学分析. 中华急诊医学杂志, 2015, 24(9):1004-1010.
2.	顾薇, 邓星奇, 余爱勇, 等. 卒中相关性肺炎危险因素的前瞻性研究. 中国呼吸与危重监护杂志, 2013, 12(2): 129-132.
3.	周曙俊, 周军, 王大明. 单核细胞人白细胞抗原 DR 监测在重症肺炎患者预后评估中的价值. 江苏大学学报(医学版), 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.	卒中相关性肺炎诊治中国专家共识组. 卒中相关性肺炎诊治中国专家共识. 中华内科杂志, 2010, 49(12):1075-1078.
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7.	张道培, 闫福岭, 徐海清, 等. 急性重症脑卒中患者单核细胞 HLA-DR 的表达变化与病情及感染的关系. 中华医院感染学杂志, 2012, 22(14):2998-3001.
8.	曹艳, 龚自力, 左尧金. 老年患者脑卒中相关性肺炎的危险因素及预后分析. 中国实用神经疾病杂志, 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.	李远玲, 赵红萍, 李晓琴. 老年卒中相关性肺炎多重耐药菌感染的危险因素分析及干预对策. 检验医学与临床, 2014, 11(5):674-675.
11.	朱刚, 余成, 钟平, 等. 神经科重症病房老年脑卒中相关性肺炎患者认知功能障碍发病机制. 中国老年学杂志, 2016, 36(10):2361-2363.
12.	Sørensen 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.	胡晓蕾, 尧银光, 武蓉珍, 等. 单核细胞人类白细胞抗原 DR 预测重症多发伤感染的临床应用研究. 中华医院感染学杂志, 2016, 26(11): 2456-2458.
16.	张新颜, 闫福岭, 邵伟波, 等. 检测单核细胞 HLA-DR 和 T 淋巴细胞亚群变化对脑卒中相关性肺炎的预测价值. 中国神经免疫学和神经病学杂志, 2013, 20(6):396-399.

1. 钟明媚, 王璠, 张琳, 等. 重症监护病房卒中相关性肺炎的危险因素及病原学分析. 中华急诊医学杂志, 2015, 24(9):1004-1010.
2. 顾薇, 邓星奇, 余爱勇, 等. 卒中相关性肺炎危险因素的前瞻性研究. 中国呼吸与危重监护杂志, 2013, 12(2): 129-132.
3. 周曙俊, 周军, 王大明. 单核细胞人白细胞抗原 DR 监测在重症肺炎患者预后评估中的价值. 江苏大学学报(医学版), 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. 卒中相关性肺炎诊治中国专家共识组. 卒中相关性肺炎诊治中国专家共识. 中华内科杂志, 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. 张道培, 闫福岭, 徐海清, 等. 急性重症脑卒中患者单核细胞 HLA-DR 的表达变化与病情及感染的关系. 中华医院感染学杂志, 2012, 22(14):2998-3001.
8. 曹艳, 龚自力, 左尧金. 老年患者脑卒中相关性肺炎的危险因素及预后分析. 中国实用神经疾病杂志, 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. 李远玲, 赵红萍, 李晓琴. 老年卒中相关性肺炎多重耐药菌感染的危险因素分析及干预对策. 检验医学与临床, 2014, 11(5):674-675.
11. 朱刚, 余成, 钟平, 等. 神经科重症病房老年脑卒中相关性肺炎患者认知功能障碍发病机制. 中国老年学杂志, 2016, 36(10):2361-2363.
12. Sørensen 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. 胡晓蕾, 尧银光, 武蓉珍, 等. 单核细胞人类白细胞抗原 DR 预测重症多发伤感染的临床应用研究. 中华医院感染学杂志, 2016, 26(11): 2456-2458.
16. 张新颜, 闫福岭, 邵伟波, 等. 检测单核细胞 HLA-DR 和 T 淋巴细胞亚群变化对脑卒中相关性肺炎的预测价值. 中国神经免疫学和神经病学杂志, 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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