External Validation of the ISAN, A2DS2, and AIS-APS Scores for Predicting Stroke-Associated Pneumonia
Section snippets
Background
Pneumonia is a major medical complication after stroke that contributes to increased morbidity and mortality among the stroke population. Patients with stroke-associated pneumonia (SAP) have a 3-fold increased risk of 30-day mortality after adjusting for admission severity.1 SAP risk prediction could help in targeting interventions to reduce the incidence at highest-risk patients and to facilitate appropriate patient selection for clinical trials using preventive interventions. Recently,
Study Population
Consecutive patients admitted to the SIPIA Registry participating hospitals between October 2014 and May 2016 were included. The SIPIA is a prospective, observational, and multicenter study developed in 7 hospitals from the south of Spain. Three of them included the stroke unit, and the other 4 were first-level hospitals. The study was approved by our institutional review committee. Patients eligible for the study were those older than 18 years old with ischemic or hemorrhagic stroke (excluding
Results
The baseline characteristics of the sample are summarized in Table 1. Among 201 included patients, the SAP rate was 15.5% (31). The C statistic was .83 (95% confidence interval [CI], .76-.91) for the ISAN score, .80 (95% CI, .70-.89) for the A2DS2 score, and .82 (95% CI, .74-.90) for AIS-APS score, suggesting good discrimination. The Hosmer–Lemeshow goodness-of-fit test showed that ISAN and AIS-APS scores also had a good calibration (Cox and Snell R2 = .206 and .174, respectively), but not the
Discussion
Our results showed that the ISAN, A2DS2, and AIS-APS scores have a good discrimination in SAP risk prediction. Also in AIS-APS and ISAN scores, this study has demonstrated a good calibration in the SIPIA cohort. A2DS2 score calibration in our sample (Cox and Snell R2 = .152) differs from original results. This is the first prospective study for comparative ISAN, A2DS2, and AIS-APS external validation. Such scores allow the identification of patients at high risk of SAP, which is important for
Conclusion
In conclusion, our study prospectively validates the predictive accuracy of the A2DS2, AIS-APS, and ISAN scores in SAP identification. Such scores are a simple way to identify high-risk SAP patients, and they might be helpful for image or laboratory marker detection in those patients in clinical routine and stroke trials.
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Grant support: This project was partially funded by the Instituto de Salud Carlos III (ISCIII) project PI14/00971. The Improving Translational Research Potential at the Institute of Biomedicine of Seville project has the registration number REGPOT-2013-1.