Accuracy of different screening tools for ischemic stroke-associated pneumonia: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

CHENG Linwen ¹ , ZHENG Lei ¹ , TAN Jianhua ² , FANG Leyi ¹ , XIA Yunhui ¹ , CAI Tingting ¹ , MO Hangfeng ¹ , SHI Yin ³ ,  SHEN Jiantong ¹

1. Department of Huzhou University School of Nursing Science, Huzhou 313000, P. R. China;
2. Wuxing District People’s Hospital of Huzhou city, Huzhou 313000, P. R. China;
3. Department of Critical Care Medicine, Deqing Couty People’s Hospital, Huzhou 313200, P. R. China;

Corresponding author：

SHEN Jiantong, Email: sjiantong@163.com

Keywords：

Stroke; Stroke-associated pneumonia; Screening tools; Accuracy; Network meta-analysis

DOI：

10.7507/1672-2531.202410002

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the accuracy of different stroke-associated pneumonia (SAP) assessment tools. Methods The PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, WanFang Data, and CBM databases were electronically searched to collect studies related to the objects from inception to January 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A network meta-analysis was then performed by using Meta-disc 1.4 and Stata 17.0 software. Results A total of 20 studies were included, involving 6 SAP assessment tools. The results of network meta-analysis showed that the sensitivity of AIS-APS was higher than that of A2DS2, and the specificity of A2DS2 was higher than that of PANTHERIS, and the difference was statistically significant. The sensitivity SUCRA values from high to low were: AIS-APS (95.6%) > PANTHERIS (46.7%) > Kwon (44.1%) > A2DS2 (40.5%) > Chumbler (37.3%) > ISAN (35.8%). The specificity SUCRA values from high to low were: A2DS2 (84.0%) > Chumbler (66.0%) > ISAN (59.5%) > AIS-APS (41.4%) > Kwon (37.0%) > PANTHERIS (12.1%) Conclusion Among the common stroke-associated pneumonia screening tools used to screen patients with ischemic stroke, AIS-APS has the highest sensitivity and A2DS2 has the highest specificity.

1.	Finlayson O, Kapral M, Hall R, et al. Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology, 2011, 77(14): 1338-1345.
2.	Li J, Zhang P, Wu S, et al. Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome. Ther Adv Neurol Disord, 2019, 12: 1756286419873264.
3.	王拥军, 陈玉国, 吕传柱, 等. 卒中相关性肺炎诊治中国专家共识(2019更新版). 中国卒中杂志, 2019, 14(12): 1251-1262.
4.	Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand, 2018, 138(4): 293-300.
5.	Smith CJ, Bray BD, Hoffman A, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care. A UK multicenter cohort study. J Am Heart Assoc, 2015, 4(1): e001307.
6.	Yu YJ, Weng WC, Su FC, et al. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke. J Clin Neurosci, 2016, 33: 124-128.
7.	Katzan IL, Cebul RD, Husak SH, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology, 2003, 60(4): 620-625.
8.	Ali AN, Howe J, Majid A, et al. The economic cost of stroke-associated pneumonia in a UK setting. Top Stroke Rehabil, 2018, 25(3): 214-223.
9.	Lobo Chaves MA, Gittins M, Bray B, et al. Do stroke care processes modify clinical outcomes in patients with stroke-associated pneumonia. A registry cohort study in England and wales. Cerebrovasc Dis, 2023, 52(1): 21-27.
10.	Elkind MSV, Boehme AK, Smith CJ, et al. Infection as a stroke risk factor and determinant of outcome after stroke. Stroke, 2020, 51(10): 3156-3168.
11.	Nam KW, Kim TJ, Lee JS, et al. High neutrophil-to-lymphocyte ratio predicts stroke-associated pneumonia. Stroke, 2018, 49(8): 1886-1892.
12.	Badve MS, Zhou Z, van de Beek D, et al. Frequency of post-stroke pneumonia: systematic review and meta-analysis of observational studies. Int J Stroke, 2019, 14(2): 125-136.
13.	张秀梅, 丑晓华, 马翠. 急性脑梗死患者卒中相关性肺炎的危险因素与抗感染治疗的耐药性分析. 抗感染药学, 2019, 16(12): 2046-2051.
14.	Helmy TA, Abd-Elhady MA, Abdou M. Prediction of ischemic stroke-associated pneumonia: a comparison between 3 scores. J Stroke Cerebrovasc Dis, 2016, 25(11): 2756-2761.
15.	张国倩. 淋巴细胞单核细胞比值联合A~2DS~2评分对卒中相关性肺炎的预测价值. 天津: 天津医科大学, 2019.
16.	韩蕾, 刘勇, 张秋霞. A2DS2和AIS-APS量表对老年脑卒中相关性肺炎的预测意义. 中华肺部疾病杂志(电子版), 2021, 14(3): 335-337.
17.	Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies. Ann Intern Med, 2021, 174(11): 1592-1599.
18.	黄玉香, 沈建通, 刘雨今. 诊断试验准确性比较研究偏倚风险评价工具QUADAS-C解读. 中国循证医学杂志, 2022, 22(9): 1108-1116.
19.	Zapata-Arriaza E, Moniche F, Blanca PG, et al. External validation of the ISAN, A2DS2, and AIS-APS scores for predicting stroke-associated pneumonia. J Stroke Cerebrovasc Dis, 2018, 27(3): 673-676.
20.	Gong S, Zhou Z, Zhou M, et al. Validation of risk scoring models for predicting stroke-associated pneumonia in patients with ischaemic stroke. Stroke Vasc Neurol, 2016, 1(3): 122-126.
21.	杭景, 潘希丁, 戈念念, 等. 缺血性卒中患者卒中相关性肺炎的预测: 6种评分的比较. 国际脑血管病杂志, 2017, 25(11): 972-978.
22.	罗小娜, 刘新生, 王昆, 等. 两种量表对急性缺血性脑卒中相关性肺炎预测价值的比较. 中华老年心脑血管病杂志, 2018, 20(11): 1183-1186.
23.	苑艺. 西宁地区急性缺血性卒中相关性肺炎的危险因素及ISAN、A2DS2评分预测价值研究. 青海: 青海大学, 2018.
24.	张亚蓬, 杨爱明. A2DS2评分与AIS-APS评分在预测卒中相关肺炎中的表现. 心肺血管病杂志, 2019, 38(6): 624-628.
25.	王功硕, 史家欣, 张广慧, 等. 不同评分量表在预测卒中相关性肺炎中的价值比较. 中国医师进修杂志, 2022, 45(11): 984-991.
26.	Ji R, Shen H, Pan Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke, 2013, 44(5): 1303-1309.
27.	焦娇. 卒中相关肺炎的临床预测评分效能评价及细菌流行病学和耐药性调查. 江苏: 东南大学, 2019.
28.	Cugy E, Sibon I. Stroke-associated pneumonia risk score: validity in a French stroke unit. J Stroke Cerebrovasc Dis, 2017, 26(1): 225-229.
29.	单晔, 陈冬勤. 不同卒中相关性肺炎预测量表在缺血性脑卒中患者中预测作用的比较. 护理学报, 2018, 25(24): 43-46.
30.	李芳, 徐丽华, 冀瑞俊, 等. 急性缺血性卒中相关肺炎评分临床应用价值分析. 中国卒中杂志, 2020, 15(11): 1204-1209.
31.	王娜, 刘芦姗, 王丰容. 四种评分系统对缺血性脑卒中相关性肺炎的预测价值比较. 中国康复理论与实践, 2018, 24(6): 696-701.
32.	杨锐, 李皓, 王晓鹏, 等. A2DS2与AIS-APS评分预测卒中相关肺炎准确性的比较. 当代医学, 2019, 25(9): 164-166.
33.	张锐, 黄荣, 谭登云, 等. 卒中相关性肺炎影响因素的模型构建及其与3种预测评分系统的比较. 中华医院感染学杂志, 2022, 32(18): 2767-2771.
34.	孙怡玮. 脑梗死患者卒中相关性肺炎的危险预测因素研究. 上海: 同济大学, 2019.
35.	Ramírez-Moreno JM, Martínez-Acevedo M, Cordova R, et al. External validation of the A2SD2 and ISAN scales for predicting infectious respiratory complications of ischaemic stroke. Neurologia (Engl Ed), 2019, 34(1): 14-21.
36.	Elhasin H, Szolics M, Hassan A, et al. Risk scores for predicting stroke associated pneumonia: validity of A2DS2 and ISAN scores. J Neurol Sci, 2019, 405: 41-42.
37.	杜庆霞, 丁宁, 李维轶, 等. AIS-APS评分在预测急性缺血性卒中相关性肺炎中的应用价值研究. 中华急诊医学杂志, 2016, 25(10): 1268-1271.
38.	Harms H, Hoffmann S, Malzahn U, et al. Decision-making in the diagnosis and treatment of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry, 2012, 83(12): 1225-1230.
39.	Huang J, Liu M, He W, et al. Use of the A2DS2 scale to predict morbidity in stroke-associated pneumonia: a systematic review and meta-analysis. BMC Neurol, 2021, 21(1): 33.
40.	Zhang X, Yu S, Wei L, et al. The A2DS2 score as a predictor of pneumonia and in-hospital death after acute ischemic stroke in Chinese populations. PLoS One, 2016, 11(3): e0150298.

1. Finlayson O, Kapral M, Hall R, et al. Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology, 2011, 77(14): 1338-1345.
2. Li J, Zhang P, Wu S, et al. Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome. Ther Adv Neurol Disord, 2019, 12: 1756286419873264.
3. 王拥军, 陈玉国, 吕传柱, 等. 卒中相关性肺炎诊治中国专家共识(2019更新版). 中国卒中杂志, 2019, 14(12): 1251-1262.
4. Teh WH, Smith CJ, Barlas RS, et al. Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome. Acta Neurol Scand, 2018, 138(4): 293-300.
5. Smith CJ, Bray BD, Hoffman A, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care. A UK multicenter cohort study. J Am Heart Assoc, 2015, 4(1): e001307.
6. Yu YJ, Weng WC, Su FC, et al. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke. J Clin Neurosci, 2016, 33: 124-128.
7. Katzan IL, Cebul RD, Husak SH, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology, 2003, 60(4): 620-625.
8. Ali AN, Howe J, Majid A, et al. The economic cost of stroke-associated pneumonia in a UK setting. Top Stroke Rehabil, 2018, 25(3): 214-223.
9. Lobo Chaves MA, Gittins M, Bray B, et al. Do stroke care processes modify clinical outcomes in patients with stroke-associated pneumonia. A registry cohort study in England and wales. Cerebrovasc Dis, 2023, 52(1): 21-27.
10. Elkind MSV, Boehme AK, Smith CJ, et al. Infection as a stroke risk factor and determinant of outcome after stroke. Stroke, 2020, 51(10): 3156-3168.
11. Nam KW, Kim TJ, Lee JS, et al. High neutrophil-to-lymphocyte ratio predicts stroke-associated pneumonia. Stroke, 2018, 49(8): 1886-1892.
12. Badve MS, Zhou Z, van de Beek D, et al. Frequency of post-stroke pneumonia: systematic review and meta-analysis of observational studies. Int J Stroke, 2019, 14(2): 125-136.
13. 张秀梅, 丑晓华, 马翠. 急性脑梗死患者卒中相关性肺炎的危险因素与抗感染治疗的耐药性分析. 抗感染药学, 2019, 16(12): 2046-2051.
14. Helmy TA, Abd-Elhady MA, Abdou M. Prediction of ischemic stroke-associated pneumonia: a comparison between 3 scores. J Stroke Cerebrovasc Dis, 2016, 25(11): 2756-2761.
15. 张国倩. 淋巴细胞单核细胞比值联合A~2DS~2评分对卒中相关性肺炎的预测价值. 天津: 天津医科大学, 2019.
16. 韩蕾, 刘勇, 张秋霞. A2DS2和AIS-APS量表对老年脑卒中相关性肺炎的预测意义. 中华肺部疾病杂志(电子版), 2021, 14(3): 335-337.
17. Yang B, Mallett S, Takwoingi Y, et al. QUADAS-C: a tool for assessing risk of bias in comparative diagnostic accuracy studies. Ann Intern Med, 2021, 174(11): 1592-1599.
18. 黄玉香, 沈建通, 刘雨今. 诊断试验准确性比较研究偏倚风险评价工具QUADAS-C解读. 中国循证医学杂志, 2022, 22(9): 1108-1116.
19. Zapata-Arriaza E, Moniche F, Blanca PG, et al. External validation of the ISAN, A2DS2, and AIS-APS scores for predicting stroke-associated pneumonia. J Stroke Cerebrovasc Dis, 2018, 27(3): 673-676.
20. Gong S, Zhou Z, Zhou M, et al. Validation of risk scoring models for predicting stroke-associated pneumonia in patients with ischaemic stroke. Stroke Vasc Neurol, 2016, 1(3): 122-126.
21. 杭景, 潘希丁, 戈念念, 等. 缺血性卒中患者卒中相关性肺炎的预测: 6种评分的比较. 国际脑血管病杂志, 2017, 25(11): 972-978.
22. 罗小娜, 刘新生, 王昆, 等. 两种量表对急性缺血性脑卒中相关性肺炎预测价值的比较. 中华老年心脑血管病杂志, 2018, 20(11): 1183-1186.
23. 苑艺. 西宁地区急性缺血性卒中相关性肺炎的危险因素及ISAN、A2DS2评分预测价值研究. 青海: 青海大学, 2018.
24. 张亚蓬, 杨爱明. A2DS2评分与AIS-APS评分在预测卒中相关肺炎中的表现. 心肺血管病杂志, 2019, 38(6): 624-628.
25. 王功硕, 史家欣, 张广慧, 等. 不同评分量表在预测卒中相关性肺炎中的价值比较. 中国医师进修杂志, 2022, 45(11): 984-991.
26. Ji R, Shen H, Pan Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke, 2013, 44(5): 1303-1309.
27. 焦娇. 卒中相关肺炎的临床预测评分效能评价及细菌流行病学和耐药性调查. 江苏: 东南大学, 2019.
28. Cugy E, Sibon I. Stroke-associated pneumonia risk score: validity in a French stroke unit. J Stroke Cerebrovasc Dis, 2017, 26(1): 225-229.
29. 单晔, 陈冬勤. 不同卒中相关性肺炎预测量表在缺血性脑卒中患者中预测作用的比较. 护理学报, 2018, 25(24): 43-46.
30. 李芳, 徐丽华, 冀瑞俊, 等. 急性缺血性卒中相关肺炎评分临床应用价值分析. 中国卒中杂志, 2020, 15(11): 1204-1209.
31. 王娜, 刘芦姗, 王丰容. 四种评分系统对缺血性脑卒中相关性肺炎的预测价值比较. 中国康复理论与实践, 2018, 24(6): 696-701.
32. 杨锐, 李皓, 王晓鹏, 等. A2DS2与AIS-APS评分预测卒中相关肺炎准确性的比较. 当代医学, 2019, 25(9): 164-166.
33. 张锐, 黄荣, 谭登云, 等. 卒中相关性肺炎影响因素的模型构建及其与3种预测评分系统的比较. 中华医院感染学杂志, 2022, 32(18): 2767-2771.
34. 孙怡玮. 脑梗死患者卒中相关性肺炎的危险预测因素研究. 上海: 同济大学, 2019.
35. Ramírez-Moreno JM, Martínez-Acevedo M, Cordova R, et al. External validation of the A2SD2 and ISAN scales for predicting infectious respiratory complications of ischaemic stroke. Neurologia (Engl Ed), 2019, 34(1): 14-21.
36. Elhasin H, Szolics M, Hassan A, et al. Risk scores for predicting stroke associated pneumonia: validity of A2DS2 and ISAN scores. J Neurol Sci, 2019, 405: 41-42.
37. 杜庆霞, 丁宁, 李维轶, 等. AIS-APS评分在预测急性缺血性卒中相关性肺炎中的应用价值研究. 中华急诊医学杂志, 2016, 25(10): 1268-1271.
38. Harms H, Hoffmann S, Malzahn U, et al. Decision-making in the diagnosis and treatment of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry, 2012, 83(12): 1225-1230.
39. Huang J, Liu M, He W, et al. Use of the A2DS2 scale to predict morbidity in stroke-associated pneumonia: a systematic review and meta-analysis. BMC Neurol, 2021, 21(1): 33.
40. Zhang X, Yu S, Wei L, et al. The A2DS2 score as a predictor of pneumonia and in-hospital death after acute ischemic stroke in Chinese populations. PLoS One, 2016, 11(3): e0150298.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesAccuracy of different screening tools for ischemic stroke-associated pneumonia: a network meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Format

Content