Hospital Acquired Pneumonia Is Linked to Right Hemispheric Peri-Insular StrokeReportar como inadecuado




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Purpose

Hospital acquired pneumonia HAP is a major complication of stroke. We sought to determine associations between infarction of specific brain regions and HAP.

Methods

215 consecutive acute stroke patients with HAP 2003–2009 were carefully matched with 215 non-pneumonia controls by gender, then NIHSS, then age. Admission imaging and binary masks of infarction were registered to MNI-152 space. Regional atlas and voxel-based log-odds were calculated to assess the relationship between infarct location and the likelihood of HAP. An independently validated penalized conditional logistic regression model was used to identify HAP associated imaging regions.

Results

The HAP and control patients were well matched by gender 100%, age 95% within 5-years, NIHSS 98% within 1-point, infarct size, dysphagia, and six other clinical variables. Right hemispheric infarcts were more frequent in patients with HAP versus controls 43.3% vs. 34.0%, p = 0.054, whereas left hemispheric infarcts were more frequent in controls 56.7% vs. 44.7%, p = 0.012; there was no significant difference between groups in the rate of brainstem strokes p = 1.0. Of the 10 most infarcted regions, only right insular cortex volume was different in HAP versus controls 20 vs. 12 ml, p = 0.02. In univariate analyses, the highest log-odds regions for pneumonia were right hemisphere, cerebellum, and brainstem. The best performing multivariate model selected 7 brain regions of infarction and 2 infarct volume-based variables independently associated with HAP.

Conclusions

HAP is associated with right hemispheric peri-insular stroke. These associations may be related to autonomic modulation of immune mechanisms, supporting recent hypotheses of stroke mediated immune suppression.



Autor: André Kemmling , Michael H. Lev, Seyedmehdi Payabvash, Rebecca A. Betensky, Jing Qian, Shihab Masrur, Lee H. Schwamm

Fuente: http://plos.srce.hr/



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