{
  "abstract": "Background: Stroke-associated pneumonia (SAP) is a common complication following acute ischemic stroke, yet its early occurrence patterns, nonlinear risk factors, and time-dependent prognostic impact remain incompletely characterized. We investigated SAP incidence, temporal distribution, risk factors, and independent impact on in-hospital outcomes.\n\nMethods: This single-center retrospective cohort study included 3,347 consecutive patients with acute ischemic stroke (2019–2025). SAP was diagnosed within 7 days after admission using consensus criteria. Cox models with restricted cubic splines identified risk factors and nonlinear relationships. Time-dependent Cox models, Gamma generalized linear models, and logistic regression were used to assess associations between SAP and in-hospital outcomes. Multiple imputation, complete-case, and landmark analyses verified robustness.\n\nResults: SAP developed in 428 patients (12.8%), with 55.1% occurring within 72 h (peak day 3). Independent risk factors included older age (HR 1.02), pre-stroke mRS 3–5 (HR 1.39), COPD (HR 1.69), cardioembolism (HR 1.71), dysphagia (HR 2.02), and nasogastric tube insertion within 48 h (HR 2.31) (all p < 0.05). Admission NIHSS, neutrophil-lymphocyte ratio, and albumin showed nonlinear associations with SAP risk (all P-nonlinear <0.05). Time-dependent analyses revealed SAP independently associated with in-hospital death (HR 2.34), ICU transfer (HR 2.81), invasive mechanical ventilation (HR 3.47), prolonged length of stay (RoM 1.35), and poor functional outcome (OR 1.90) (all p < 0.001). Sensitivity analyses confirmed robustness.\n\nConclusion: SAP occurs early after acute ischemic stroke, with identifiable risk factors exhibiting nonlinear relationships, and independently predicts adverse in-hospital outcomes. Findings support forward-shifted preventive strategies, including early swallowing assessment, feeding pathway optimization, airway protection, and nutritional support, in high-risk patients during the first days of hospitalization.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurology, Qianwei Hospital of Jilin Province, Changchun",
    "Department of Respiratory Medicine, Qianwei Hospital of Jilin Province",
    "Department of Thoracic Surgery, Qianwei Hospital of Jilin Province, Changchun",
    "Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Shitong Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Qiaomei Yan"
    },
    {
      "affs": [
        0
      ],
      "name": "Zheng Wang"
    },
    {
      "affs": [
        1
      ],
      "name": "Rudong Xie"
    },
    {
      "affs": [
        2
      ],
      "name": "Ye Tao"
    },
    {
      "affs": [
        3
      ],
      "name": "Yingju Jin"
    },
    {
      "affs": [
        0
      ],
      "name": "Wendong Zuo"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/76d0zkzd0dj8y.bib",
  "cited_by": 0,
  "doi": "10.3389/fneur.2026.1841237",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727604/?tool=EBI",
  "id": "76d0zkzd0dj8y",
  "issns": [
    "1664-2295"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1841237/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "3616|Dysphagia Assessment and Management"
    ]
  ],
  "openalex": "W7223038325",
  "pdf_url": "https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2026.1841237/pdf",
  "pmcid": "PMC13727604",
  "pmid": "42978660",
  "published": "2026-10-20",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/76d0zkzd0dj8y.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:16Z",
      "native_id": "10.3389/fneur.2026.1841237",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fneur.2026.1841237/full"
    },
    {
      "first_seen": "2026-11-04T15:20:45Z",
      "native_id": "PMC:PMC13727604",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13727604"
    },
    {
      "first_seen": "2026-11-06T12:23:27Z",
      "native_id": "PMC13727604",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fneur.2026.1841237"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:1664-2295",
      "subfield": "neurology"
    }
  ],
  "title": "Stroke-associated pneumonia after acute ischemic stroke: early temporal dynamics, nonlinear risk factors, and time-dependent prognostic impact",
  "title_text": "Stroke-associated pneumonia after acute ischemic stroke: early temporal dynamics, nonlinear risk factors, and time-dependent prognostic impact",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:20:45Z",
  "url": "https://research.draconitic.com/paper/76d0zkzd0dj8y",
  "venue": "Frontiers in Neurology",
  "versions": []
}