SAP occurs early after acute ischemic stroke, with identifiable risk factors exhibiting nonlinear relationships, and independently predicts adverse in-hospital outcomes.
Stroke-associated pneumonia developed in 12.8% of patients with acute ischemic stroke, and most cases occurred early.
Several clinical factors were independent risk factors for SAP in Cox models.
Admission NIHSS, neutrophil-lymphocyte ratio, and albumin had nonlinear associations with SAP risk.
SAP was independently associated with in-hospital death and with escalation of care.
SAP was independently associated with longer hospital stay and poor functional outcome.
Sensitivity analyses confirmed the robustness of the findings.
The authors conclude that findings support earlier, forward-shifted preventive strategies in high-risk patients during the first days of hospitalization.
This study reviewed records of 3,347 patients treated at one hospital for ischemic stroke (stroke caused by a blocked blood vessel in the brain) between 2019 and 2025. About 1 in 8 patients (12.8%) developed pneumonia within the first week, and more than half of these cases appeared within the first three days, peaking on day 3. Patients were more likely to develop pneumonia if they were older, were already disabled before the stroke, had COPD, had a stroke caused by a clot from the heart, had trouble swallowing, or needed a feeding tube through the nose within 48 hours. Stroke severity at admission, a blood marker of inflammation (neutrophil-lymphocyte ratio), and blood albumin (a nutrition marker) related to pneumonia risk in non-straight-line ways, meaning risk did not rise or fall at a constant rate. Patients who developed pneumonia had a higher risk of dying in hospital, being moved to intensive care, needing a breathing machine, staying longer, and having poor functional recovery. This research suggests that prevention efforts for pneumonia after stroke may need to start early, in the first days of hospital care, for example through early swallowing checks, careful choices about how patients are fed, protecting the airway, and attention to nutrition. Because this was a retrospective study at a single center, it shows associations rather than proving that these measures prevent pneumonia or improve outcomes.
Zhang S, Yan Q, Wang Z, Xie R, Tao Y, Jin Y, et al.. (2026). Stroke-associated pneumonia after acute ischemic stroke: early temporal dynamics, nonlinear risk factors, and time-dependent prognostic impact.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1841237