Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study

J Cereb Blood Flow Metab. 2017 Dec;37(12):3671-3682. doi: 10.1177/0271678X16671964. Epub 2016 Oct 14.

Abstract

Stroke-associated pneumonia is a frequent complication after stroke associated with poor outcome. Dysphagia is a known risk factor for stroke-associated pneumonia but accumulating evidence suggests that stroke induces an immunodepressive state increasing susceptibility for stroke-associated pneumonia. We aimed to confirm that stroke-induced immunodepression syndrome is associated with stroke-associated pneumonia independently from dysphagia by investigating the predictive properties of monocytic HLA-DR expression as a marker of immunodepression as well as biomarkers for inflammation (interleukin-6) and infection (lipopolysaccharide-binding protein). This was a prospective, multicenter study with 11 study sites in Germany and Spain, including 486 patients with acute ischemic stroke. Daily screening for stroke-associated pneumonia, dysphagia and biomarkers was performed. Frequency of stroke-associated pneumonia was 5.2%. Dysphagia and decreased monocytic HLA-DR were independent predictors for stroke-associated pneumonia in multivariable regression analysis. Proportion of pneumonia ranged between 0.9% in the higher monocytic HLA-DR quartile (≥21,876 mAb/cell) and 8.5% in the lower quartile (≤12,369 mAb/cell). In the presence of dysphagia, proportion of pneumonia increased to 5.9% and 18.8%, respectively. Patients without dysphagia and normal monocytic HLA-DR expression had no stroke-associated pneumonia risk. We demonstrate that dysphagia and stroke-induced immunodepression syndrome are independent risk factors for stroke-associated pneumonia. Screening for immunodepression and dysphagia might be useful for identifying patients at high risk for stroke-associated pneumonia.

Keywords: Acute stroke; immunology; infection; inflammation; macrophages.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Deglutition Disorders / etiology*
  • Deglutition Disorders / immunology
  • Female
  • HLA-DR Antigens / analysis
  • HLA-DR Antigens / immunology
  • Humans
  • Immune Tolerance*
  • Interleukin-6 / analysis
  • Interleukin-6 / immunology
  • Macrophages / immunology
  • Male
  • Middle Aged
  • Pneumonia / diagnosis
  • Pneumonia / etiology*
  • Pneumonia / immunology
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Stroke / complications*
  • Stroke / immunology

Substances

  • HLA-DR Antigens
  • Interleukin-6