Skip to content
DraconiticResearch
Search Sources API
203,234 studies31 sourcesUpdated 35 min ago
Peer-reviewedCC BY 4.0Frontiers in Neurology

Stroke-associated pneumonia after acute ischemic stroke: early temporal dynamics, nonlinear risk factors, and time-dependent prognostic impact

  • Shitong Zhang1
  • Qiaomei Yan1
  • Zheng Wang1
  • Rudong Xie2
  • Ye Tao3
  • Yingju Jin4
  • Wendong Zuo1
4 affiliations
  1. 1Department of Neurology, Qianwei Hospital of Jilin Province, Changchun
  2. 2Department of Respiratory Medicine, Qianwei Hospital of Jilin Province
  3. 3Department of Thoracic Surgery, Qianwei Hospital of Jilin Province, Changchun
  4. 4Department of Rehabilitation Medicine, China-Japan Union Hospital of Jilin University
Read full textPDFDOICite

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.

Methods: 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.

Results: 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.

Conclusion: 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.

Related

  1. Elevated platelet-to-lymphocyte ratio is associated with stroke-associated pneumonia in acute ischemic stroke: a retrospective cohort study
    Tingting Duan, Chengfei Xu, Jianmei Zhan +5
    Frontiers in neurologyPeer-reviewedCC BYFull textOncologyEurope PMCCrossref
  2. Neutrophil-to-lymphocyte Ratio as a Prognostic Indicator in Patients with Nursing and Healthcare-associated Pneumonia: A Retrospective Study
    Yuki Hiraoka, Takashi Ogasawara, Ei Kishimoto +6
    Internal MedicinePeer-reviewedCC BY-NC-NDFull text1 citedOncologyJ-STAGE
  3. Activation of the phenylalanine metabolic axis is associated with adverse clinical outcomes and mitochondria-dependent bioenergetic deficiency in ischemic cardiomyocytes
    Wan-Tseng Hsu, Min-Hui Liu, Kun-Yi Chien +3
    Biology DirectPeer-reviewedCC BY-NC-ND 4.0Full textCardiovascular medicinePMC
  4. Prolonged Venous Transit on MRI as a Prognostic Biomarker in Acute Ischemic Stroke: A Feasibility Study
    Derek A. Tsang, Mona Gad, Andrew Cho +10
    AJNR: American Journal of NeuroradiologyPeer-reviewedLicence not statedFull textNeurologyPMC
  5. Integration of CURB-65 and CT Severity Score for Prognostic Prediction in Community-acquired Pneumonia.
    Ökkeş Gültekin, Orhan Özçekici, İnan Arslantaş
    Thoracic research and practicePeer-reviewedCC BY-NCFull textEpidemiology & public healthEurope PMC

Cite

BibTeXRIS
BibTeX
@article{zhang2026strokeassociated,
  title = {{Stroke-associated pneumonia after acute ischemic stroke: early temporal dynamics, nonlinear risk factors, and time-dependent prognostic impact}},
  author = {Shitong Zhang and Qiaomei Yan and Zheng Wang and Rudong Xie and Ye Tao and Yingju Jin and Wendong Zuo},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1841237},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1841237/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Stroke-associated pneumonia after acute ischemic stroke: early temporal dynamics, nonlinear risk factors, and time-dependent prognostic impact
AU  - Shitong Zhang
AU  - Qiaomei Yan
AU  - Zheng Wang
AU  - Rudong Xie
AU  - Ye Tao
AU  - Yingju Jin
AU  - Wendong Zuo
PY  - 2026
DA  - 2026/10/20
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1841237
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1841237/full
AB  - 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.  Methods: 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.  Results: 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.  Conclusion: 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.
SN  - 1664-2295
ER  -