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Dear Editor

A prospective study by Hilker et al. [1] reported that stroke-associated pneumonia occurred in 21·4% of patients and identified mechanical ventilation, multiple strokes, vertebrobasilar stroke, and dysphagia as risk factors. These patients had higher mortality rates and poorer clinical outcome. We conducted a prospective study at the University of Maiduguri Teaching Hospital titled ‘Aspiration Pneumonia in patients with stroke in Northeast Nigeria’, between January 2005 and May 2011. We identified the frequency and factors predicting the development of aspiration pneumonia.

Aspiration pneumonia occurred in 12·4% of stroke patients. Factors associated with the development of aspiration pneumonia suggested by regression analysis (Table 1) are: age >60 years; Glasgow coma score ≤12; dysphagia; dysphasia; modified Rankin disability score ≥4; National Institutes of Health Stroke Score ≥11; Barthel Activity of Daily Living (ADL) index <30. These patients had a higher 60-day fatality (75·4% versus 9·4%; P ≤ 0·001, χ2 test) and lower duration of stay (25·3 ± 17·5 versus 34·6 ± 28·3; P = 0·01).

Table 1. Independent predictors for the development of aspiration pneumonia
Independent variableOR95% CIP-value
  1. Logistic regression analysis of variables, P < 0·05.

Age >602·31·37–3·910·002
Elevated white blood cell count >8 × 109/l1·40·70–3·800·344
Initial Glascow coma scale <124·52·60–8·00<0·001
Dysphagia12·16·50–22·70<0·001
Dysphasia2·21·29–3·700·004
Admission mRDS >44·11·43–11·500·008
Admission NIHSS >112·51·34–4·660·004
Admission Barthel ADL index <3016·94·07–70·29<0·001

In contrast to the studies by Hilker et al. [1] and Langmore et al. [2], the lower rate of pneumonia in our patients may be due to differences in definition, identification, and diagnosis of patients. We did not include other causes of pneumonia not attributed to aspiration; this may have also affected the rate. Most of our patient had no neuroimaging, and so we could not assess the effect of stroke sub-type, area, and size of lesion with these predictors as it influences the development of aspiration pneumonia. We also did not study the influence of nasogastric tube insertion as in the study by Nakajoh et al. [3].

Finally, our study agrees with the other authors [1, 2, 4] that aspiration pneumonia is associated with severe stroke and higher mortality rate, and prevention of pneumonias in stroke patient should be a treatment priority.

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