Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Mar;24(3):680-6.
doi: 10.1016/j.jstrokecerebrovasdis.2014.11.014. Epub 2015 Jan 16.

A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke

Adam J Friedant  1 , Brittany M Gouse  1 , Amelia K Boehme  2 , James E Siegler  3 , Karen C Albright  4 , Dominique J Monlezun  1 , Alexander J George  1 , Timothy Mark Beasley  5 , Sheryl Martin-Schild  6
Affiliations

A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke

Adam J Friedant et al. J Stroke Cerebrovasc Dis. 2015 Mar.

Abstract

Background: Hospital-acquired infections (HAIs) are a major cause of morbidity and mortality in acute ischemic stroke patients. Although prior scoring systems have been developed to predict pneumonia in ischemic stroke patients, these scores were not designed to predict other infections. We sought to develop a simple scoring system for any HAI.

Methods: Patients admitted to our stroke center (July 2008-June 2012) were retrospectively assessed. Patients were excluded if they had an in-hospital stroke, unknown time from symptom onset, or delay from symptom onset to hospital arrival greater than 48 hours. Infections were diagnosed via clinical, laboratory, and imaging modalities using standard definitions. A scoring system was created to predict infections based on baseline patient characteristics.

Results: Of 568 patients, 84 (14.8%) developed an infection during their stays. Patients who developed infection were older (73 versus 64, P < .0001), more frequently diabetic (43.9% versus 29.1%, P = .0077), and had more severe strokes on admission (National Institutes of Health Stroke Scale [NIHSS] score 12 versus 5, P < .0001). Ranging from 0 to 7, the overall infection score consists of age 70 years or more (1 point), history of diabetes (1 point), and NIHSS score (0-4 conferred 0 points, 5-15 conferred 3 points, >15 conferred 5 points). Patients with an infection score of 4 or more were at 5 times greater odds of developing an infection (odds ratio, 5.67; 95% confidence interval, 3.28-9.81; P < .0001).

Conclusion: In our sample, clinical, laboratory, and imaging information available at admission identified patients at risk for infections during their acute hospitalizations. If validated in other populations, this score could assist providers in predicting infections after ischemic stroke.

Keywords: Infection; acute ischemic stroke; modeling; outcome; risk factors.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Receiver Operating Characteristic Curve for the HAI Predictor Score, the UTI Prediction Score, the Pneumonia Prediction score and the bacteremia prediction score
Figure 2
Figure 2. Distribution of HAI prediction Score
Figure 3
Figure 3. Distribution of UTI Prediction Score
Figure 4
Figure 4. Distribution of PNA Prediction Score
Figure 5
Figure 5. Distribution of Bacteremia Prediction Score
See this image and copyright information in PMC

References

    1. Elmsley HC, Hopkins SJ. Acute ischaemic stroke and infection: Recent and emerging concepts. Lancet Neurol. 2008;7(4):341–353. - PubMed
    1. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–332. - PubMed
    1. Diederichs C, Berger K, Bartels DB. The measurement of multiple chronic diseases--a systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci. 2011;66:301–311. - PubMed
    1. Chamorro A, Urra X, Planas AM. Infection after acute ischemic stroke: A manifestation of brain-induced immunodepression. Stroke. 2007;38:1097–1103. - PubMed
    1. Ingeman A, Andersen G, Hundborg HH, et al. In-hospital medical complications, length of stay, and mortality among stroke unit patients. Stroke. 2011;42(11):3214–3218. - PubMed

Publication types

MeSH terms