ArticleInternational journal of stroke : official journal of the International Stroke Society2023
Does stroke-associated pneumonia play an important role on risk of in-hospital mortality associated with severe stroke? A four-way decomposition analysis of a national cohort of stroke patients.
Article in International journal of stroke : official journal of the International Stroke Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- European stroke organisation guideline on stroke-associated pneumonia.European stroke journal · 2026Guideline
- Procalcitonin and biomarkers for stroke-associated pneumonia: a systematic review and meta-analysis.BMC pulmonary medicine · 2025Pooled it
- CHOSEN: A Randomized Controlled Feasibility Trial.Journal of the American Heart Association · 2025Trial
- Predictive value of lipopolysaccharide for cerebral-cardiac syndrome, stroke-associated pneumonia, and prognosis in acute ischemic stroke.Biomarker research · 2026Article
- Post-stroke facial palsy: Prevalence, recovery patterns within the first 7 days, risk factors, and effect of hyperacute treatments.Clinical rehabilitation · 2026Article
- Frailty combined with nutritional risk for predicting stroke-associated pneumonia: a cohort study based on a nomogram model.Frontiers in neurology · 2026Article
- Sex Modifies the Association Between Neutrophil Percentage-to-Albumin Ratio and Stroke-Associated Pneumonia in Acute Ischemic Stroke.Journal of inflammation research · 2026Article
- Multidisciplinary and stratified non-pharmacological airway clearance intervention to prevent stroke-associated pneumonia: a quasi-experimental study.European clinical respiratory journal · 2026Article
- The impact of post-stroke pneumonia on survival and functional outcomes: A systematic review and meta-analysis.Pakistan journal of medical sciences · 2025Review
- Clinical course, causes of worsening, and outcomes of severe ischemic stroke: A prospective multicenter cohort study.Chinese medical journal · 2025Article
- The clinical value of triglyceride to high-density lipoprotein cholesterol ratio for predicting stroke-associated pneumonia after spontaneous intracerebral hemorrhage.BMC neurology · 2025Article
- Risk prediction of stroke-associated pneumonia in acute ischemic stroke with atrial fibrillation using machine learning models.Frontiers in artificial intelligence · 2025Article
- Development and validation of a machine learning-based risk prediction model for stroke-associated pneumonia in older adult hemorrhagic stroke.Frontiers in neurology · 2025Article
- Stroke-associated pneumonia with low PaOFrontiers in neurology · 2025Article
- Threshold Effect of the Lymphocyte to HDL-C Ratio on the Risk of Stroke-Associated Pneumonia After Acute Ischemic Stroke: A Retrospective Cohort Study.Journal of inflammation research · 2025Article
- The efficacy of polymyxin B in treating stroke-associated pneumonia with carbapenem-resistant Gram-negative bacteria infections: a multicenter real-world study using propensity score matching.Frontiers in pharmacology · 2025Article
- Guide to Decomposition of Causal Effects Into Mediation, Interaction, and Direct Effects: Case Study on Aerobic Exercise and Parkinson Disease.Neurology · 2024Article
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Authors and funding
4 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSevere strokes and stroke-associated pneumonia (SAP) have long been associated with poorer patient health outcomes, for example, in-hospital mortality. However, it is unclear what role SAP plays in the risk of in-hospital mortality associated with a severe stroke at admission.
methodsUsing the Sentinel Stroke National Audit Program data on stroke admissions (2013-2018) in England and Wales, we modeled the "total" effect for severe stroke on risk of in-hospital mortality. Through four-way decomposition methodology, we broke down the "total" observed risk into four components. The direct "severity on outcome only" effect, the pure indirect effect of severity mediated via SAP only, the interaction between severity and SAP when mediation is not present, and when mediation via SAP is present.
resultsOf 339,139 stroke patients included, 9.4% had SAP and 15.6% died in hospital. Of SAP patients, 45% died versus 12% of non-SAP patients. The risk ratio for in-hospital mortality associated with severe versus mild/moderate stroke (i.e. total effect) was 4.72 (95% confidence interval: 4.60-4.85). Of this, 43%-increased risk was due to additive SAP interaction, this increased to 50% for "very severe" stroke. The remaining excess relative risk was due to the direct severity on outcome effect only, that is, there was no evidence here for a mediation effect via SAP.
conclusionSAP was associated with a higher mortality in severe stroke patients. Prioritizing SAP prevention in severe stroke patients may improve in-hospital survival. Our results suggest that in severe stroke patients avoiding SAP might result in an up to 43% reduction in mortality.
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