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Abstract

Introduction. Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. This study aimed to assess the performance of calibration and discrimination of A2 DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke. Methods. A retrospective cohort study was conducted among adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital, Jakarta. Age, atrial fibrillation, dysphagia, sex (male), and stroke severity (rated with National Institute of Health Stroke Scale/NIHSS) were obtained at the beginning of admission. The subjects were followed up for up to seven days after the onset of ischemic stroke to assess the outcome (pneumonia). Calibration properties of the A2 DS2 score were assessed by Hosmer-Lemeshow test and calibration plot. Discrimination properties of the A2 DS2 score were assessed by the area under the curve (AUC). Results. A total of 281 subjects were followed up. The incidence of pneumonia in acute ischemic stroke patients was observed in 118 patients (42%). Hosmer Lemeshow test of A2 DS2 score showed p = 0,222 and calibration plot showed r = 0,982. Discrimination of A2 DS2 score was shown by the AUC value of 0,885 (95% CI 0,845-0,924). Conclusion. The A2 DS2 score has a good calibration and discrimination performance in predicting the incidence of pneumonia in patients with acute ischemic stroke.

References

1. Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI. Riset kesehatan dasar (Riskesdas) 2013. Jakarta: Kementerian Kesehatan RI; 2013. 2. Harris S, Hidayat R, Kurniawan M, Mesiano T, Rasyid A. Stroke iskemik. Dalam: Aninditha T, Wiratman W, editors. Buku ajar neurologi. Tangerang: Penerbit Kedokteran Indonesia; 2017. hal.452-3. 3. Li L, Zhang LH, Xu WP, Hu JM. Risk assessment of ischemic stroke associated pneumonia. World J Emerg Med. 2014;5(3):209-13. 4. Li Y, Song B, Fang H, Gao Y, Zhao L, Xu Y. External validation of the A2 DS2 score to predict stroke-associated pneumonia in a chinese population. Plos One. 2014;9(10):1-6. 5. Ji R, Shen H, Pan Y, Wang P, Liu G, Wang Y, et al. Novel risk score to predict pneumonia after acute ischemic stroke. Stroke. 2013;44(5):1303-9. 6. Gong S, Zhou Z, Zhou M, Lei Z, Guo J, Chen N, et al. Validation of risk scoring models for predicting stroke-associated pneumonia in patients with ischemic stroke. Stroke Vasc Neurol. 2016;1(3):122-6. 7. Hoffmann S, Malzahn U, Harms H, Koennecke HC, Berger K, Kalic M, et al. Development of a clinical score (A2DS2) to predict pneumonia in acute ischemic stroke. J Cereb Circ. 2012;43(10):2617-23. 8. Meyer BC, Hemman TM, Jackson CM, Lyden PD. Modified national institute of health stroke scale for use in stroke clinical trials. Stroke. 2002;33:1261-6. 9. Smith CJ, Kishore AK, Vail A. Diagnosis of stroke-associated pneumonia: recommendations from the Pneumonia In Stroke ConsEnsuS Group. Stroke. 2015;46:2335–40. 10. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756-63. 11. Dirnagl U, Klehmet J, Braun JS, Harms H, Meisel C, Ziemssen T, et al. Stroke induced immunodepression. Stroke. 2007;38(2 Suppl):770-3. 12. Ovbiagele B, Hills NK, Saver JL, Johnston SC. Frequency and determinants of pneumonia and urinary tract infection during stroke hospitalization. J Stroke Cerebrovasc Dis. 2006;15(5):209-13. 13. Reid JM, Dai D, Gubitz GJ, Kapral MK, Christian C, Phillips SJ. Gender differences in stroke examined in a 10-year cohort of patients admitted to a canadian teaching hospital. Stroke. 2008;39(4):1090- 5.

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