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• Vol.42 No.10
• CLINICA NEUROL, 42: 917−921, 2002
• Vol.42 No.10 contents

Original Article

Respiratory infectious complications after acute ischemic stroke

Makoto Nakajima, M.D.¹⁾²⁾, Rika Watanabe-Hara, M.D.¹⁾³⁾, Yuichiro Inatomi, M.D.¹⁾, Yoichiro Hashimoto, M.D.²⁾ and Makoto Uchino, M.D.³⁾

¹⁾Stroke Center, Saiseikai Kumamoto Hospital, ²⁾Department of Neurology, Kumamoto City Hospital, ³⁾Department of Neurology, Kumamoto University School of Medicine

Background and purpose: Respiratory infection is a frequent complication in acute ischemic stroke, but it seems to have been made light of in stroke care. The purpose of this study is to examine the clinical characteristics of respiratory infectious complications in patients with acute ischemic stroke.
Method: Two-hundred and fifty-eight consecutive patients (158 men, 100 women, 70.6±12.9 years old) with acute ischemic stroke were admitted to our hospitals between May and October in 1999. Age, gender, history of stroke, the severity of stroke on admission, stroke subtype (lacunar brain infarction, atherothrombotic brain infarction, cardioembolic brain infarction, and others), aspiration, naso-gastric tube feeding, vascular risk factors, the length of hospital stay and outcome of patients were noted. We compared them between patients with and without respiratory infections.
Results: Forty-five (17.4%) patients were developed respiratory infections. Cardioembolic stroke patients were more frequently developed respiratory infections (67%) compared with other stroke subtypes. The independent risk factors for respiratory infectious complications by multiple logistic regression model were the aspiration (OR, 5.513; 95% CI, 1.793-16.946) and the severity of stroke on admission (OR, 1.090; 95% CI, 1.034-1.150). Mortality of patients with respiratory infectious complications was as high as 24%, and all survivors discharged to another hospital. After adjustment for age and the severity of stroke, respiratory infection was one of the independent risk factors of poor stroke outcome (OR, 5.838; 95% CI, 1.792-19.018).
Conclusion: Aspiration and the severity of stroke independently predict development of respiratory infectious complication in acute ischemic stroke. Respiratory infections may make worse their stroke outcome. A measure to infectious complications and aspiration needs to be taken for the patients suffering from severe ischemic stroke.

(CLINICA NEUROL, 42: 917−921, 2002)
key words: acute ischemic stroke, respiratory infection, aspiration, outcome, length of hospital stay

(Received: 19-Aug-02)