Value of Combination of the A2DS2 Score and IL-6 in Predicting Stroke-Associated Pneumonia

Jun Yang; Yonghong Dai; Zuowen Zhang; Yue Chen

doi:10.2147/NDT.S268878

Value of Combination of the A²DS² Score and IL-6 in Predicting Stroke-Associated Pneumonia

Neuropsychiatr Dis Treat. 2020 Oct 9:16:2353-2359. doi: 10.2147/NDT.S268878. eCollection 2020.

Authors

Jun Yang¹, Yonghong Dai¹, Zuowen Zhang², Yue Chen³

Affiliations

¹ Department of Critical Care Medicine, Central Hospital of Jiangjin District, Chongqing 402260, People's Republic of China.
² Department of Neurology, Central Hospital of Jiangjin District, Chongqing 402260, People's Republic of China.
³ Department of Rehabilitation, Central Hospital of Jiangjin District, Chongqing 402260, People's Republic of China.

Abstract

Purpose: To evaluate the value of the combination of the age, atrial fibrillation, dysphagia, male sex, and National Institutes of Health Stroke Scale (A²DS²) score and serum interleukin 6 (IL-6) concentration in predicting stroke-associated pneumonia (SAP).

Patients and methods: A total of 398 patients with acute ischemic stroke (AIS) from the medical ward was included in this retrospective study. They were divided into the SAP group and non-SAP group according to the diagnostic criteria of SAP. Multivariate analysis was performed to analyze the association between the A²DS² score, serum IL-6 concentration, and SAP using a backward stepwise logistic regression model. The receiver operating characteristic (ROC) curve was used to evaluate the value of the A²DS² score, serum IL-6 concentration and combination of A²DS² score and IL-6 in predicting SAP.

Results: SAP was diagnosed in 70 patients (17.6%). Multivariate analysis showed that the A²DS² score (odds ratio [OR]: 2.25, 95% confidence interval [CI]: 1.17-4.99, P=0.017) and serum IL-6 concentration (OR: 1.76, 95% CI: 1.44-1.95, P<0.001) was independently associated with SAP after adjusting for age, smoking, hypertension, hyperlipidemia, and atrial fibrillation. When the A²DS² score, serum IL-6 concentration and combination of A²DS² score and IL-6 were employed to predict SAP, the AUC was 0.824 (SE: 0.026, 95% CI: 0.773-0.875), 0.715 (SE: 0.034, 95% CI: 0.641-0.788) and 0.917 (SE: 0.015, 95% CI: 0.887-0.946), respectively. The AUC of combinative prediction was significantly higher than independent prediction (0.917 vs. 0.824, Z=3.098, P<0.001; 0.917 vs. 0.715, Z=5.436, P<0.001).

Conclusion: The addition of serum IL-6 to the A²DS² score could significantly enhance the AUC of predicting SAP in AIS patients from the medical ward.

Keywords: A2DS2 score; interleukin 6; multivariate analysis; receiver operating characteristic curve; ROC; stroke-associated pneumonia; SAP.