Value of A2DS2 Score Combined with FT3 in Predicting Stroke-associated Pneumonia

doi:10.12114/j.issn.1007-9572.2021.00.491

Abstract

Abstract: Background　The A2DS2 score is the most commonly used scale to predict stroke-associated pneumonia （SAP），by assessing clinical symptoms. Previous studies revealed that FT3 can predict the occurrence of infection after stroke with a simple measurement method. However，it remains unclear whether free triiodothyronine （FT3） can predict the occurrence of SAP and whether the predictive value of A2DS2 score combined with FT3 for SAP can be higher. Objective　To explore the predictive value of A2DS2 score with FT3 for SAP. Methods　We retrospectively enrolled 300 acute ischemic stroke patients with and without SAP（according to relevant diagnostic criteria） from Department of Neurology，First Hospital of Shanxi Medical University in 2019. Baseline data were collected，and FT3 level and A2DS2 score were assessed within 7 days after admission. Univariate and multivariate Logistic regression analyses were performed to investigate factors associated with SAP. The receiver operating characteristic （ROC） curves of A2DS2 score，FT3 level and A2DS2 score with FT3 in discriminating SAP were plotted and their values were compared. Results　There were 43 cases with SAP and 257 without.Multivariate Logistic regression analysis showed that age≥75〔OR=4.631，95%CI（1.427，15.031）〕，atrial fibrillation〔OR=3.745，95%CI（1.154，12.153）〕，higher NIHSS score at admission〔OR=1.255，95%CI（1.061，1.486）〕，lower FT3〔OR=5.024，95%CI（1.526，16.543）〕，and higher A2DS2 score 〔OR=1.781，95%CI（1.182，2.683）〕 were independent risk factors of SAP（P<0.05）. The AUC of A2DS2 score in predicting SAP was 0.875〔95%CI（0.803，0.947）〕，with 4.5 points determined as the optimal cut-off value （sensitivity 0.689，specificity 0.957）. The AUC of FT3 was 0.874〔95%CI（0.744，0.903）〕，with 3.53 pmol/L determined as the optimal cut-off value （sensitivity 0.744，specificity 0.903）. The AUC of A2DS2 score combined with FT3 was 0.932〔95%CI（0.883，0.980）〕，with a sensitivity of 0.885 and a specificity of 0.860. The AUC of A2DS2 score with FT3 was significantly higher than that of A2DS2 score（Z=2.159，P=0.03）or FT3 （Z=2.392，P=0.02）. Conclusion　A2DS2 score combined with FT3 showed higher value in predicting SAP，facilitating early identification of patients with high risk of SAP and prompt interventions.

Key words: Stroke-associated pneumonia, Free triiodothyronine, A2DS2 score, ROC curve, Forecasting

摘要： 背景　A2DS2评分是预测卒中相关性肺炎（SAP）最常用的量表，其指标均基于临床症状。已有研究发现游离三碘甲状腺原氨酸（FT3）可以预测卒中后感染的发生，且检测方法简单。FT3是否可以预测SAP的发生、A2DS2评分联合FT3是否可以提高SAP的预测价值仍有待研究。目的　探讨A2DS2评分联合FT3对SAP的预测价值。方法　回顾性选取2019年山西医科大学第一医院神经内科收治的急性缺血性卒中（AIS）患者300例。根据SAP诊断标准，将患者分为SAP组和非SAP组。收集患者基线资料，并于入院7 d内检测FT3水平和进行A2DS2评分。采用单因素和多因素Logistic回归分析探讨AIS患者发生SAP的影响因素。绘制A2DS2评分、FT3及A2DS2评分联合FT3预测AIS患者发生SAP的受试者工作特征（ROC）曲线，并比较其预测能力。结果　SAP组43例，非SAP组257例。多因素Logistic回归分析结果显示，年龄≥75岁〔OR=4.631，95%CI（1.427，15.031）〕、心房颤动〔OR=3.745，95%CI（1.154，12.153）〕、入院时美国国立卫生研究院卒中量表（NIHSS）评分〔OR=1.255，95%CI（1.061，1.486）〕、低FT3〔OR=5.024，95%CI（1.526，16.543）〕、A2DS2评分〔OR=1.781，95%CI（1.182，2.683）〕是SAP的独立危险因素（P<0.05）。A2DS2评分预测SAP的ROC曲线下面积（AUC）为0.875〔95%CI（0.803，0.947）〕，最佳截断值为4.5分，灵敏度和特异度分别为0.689和0.957。FT3预测SAP的AUC为0.874〔95%CI（0.744，0.903）〕，最佳截断值为3.53 pmol/L，灵敏度和特异度分别为0.744和0.903。A2DS2评分联合FT3预测SAP的AUC为0.932〔95%CI（0.883，0.980）〕，灵敏度和特异度分别为0.884和0.860。A2DS2评分联合FT3的AUC高于A2DS2评分（Z=2.159，P=0.03）、FT3（Z=2.392，P=0.02）。结论　A2DS2评分联合FT3预测SAP价值高，可以早期识别SAP高风险患者，有利于及时干预和治疗。

YAO Yangyang,ZHANG Meng,TONG Shumin, et al. Value of A2DS2 Score Combined with FT3 in Predicting Stroke-associated Pneumonia　[J]. Chinese General Practice, 2021, 24(27): 3451-3456. DOI: 10.12114/j.issn.1007-9572.2021.00.491.
姚阳阳,张梦,仝淑敏等. A2DS2评分联合游离三碘甲状腺原氨酸预测卒中相关性肺炎的价值研究[J]. 中国全科医学, 2021, 24(27): 3451-3456. DOI: 10.12114/j.issn.1007-9572.2021.00.491.

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