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Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

Bacterial Pneumonia and Stroke Risk: A Nationwide Longitudinal Followup Study

Author(s): Joyce En-Hua Wang, Shih-Jen Tsai, Yen-Po Wang, Tzeng-Ji Chen, Tso-Jen Wang* and Mu-Hong Chen*

Volume 20, Issue 5, 2023

Published on: 26 January, 2024

Page: [578 - 585] Pages: 8

DOI: 10.2174/0115672026280736240108093755

Price: $65

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Abstract

Background: Pneumonia causes significant morbidity and mortality and has been associated with cardiovascular complications. Our study aimed to investigate the incidence of ischemic and hemorrhagic strokes following bacterial pneumonia.

Methods: Between 1997 and 2012, 10,931 subjects with bacterial pneumonia and 109,310 controls were enrolled from the Taiwan National Health Insurance Research Database, and were followed up to the end of 2013. The risk of stroke was estimated in Cox regression analyses with hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: When compared to the control group, subjects in the bacterial pneumonia group had a higher incidence of developing ischemic stroke (2.7% versus 0.4%, p <0.001) and hemorrhagic stroke (0.7% versus 0.1%, p <0.001). The risk of stroke increases with repeated hospitalizations due to bacterial pneumonia. Across bacterial etiologies, bacterial pneumonia was a significant risk factor among 775 subjects who developed ischemic stroke (HR, 5.72; 95% CI, 4.92-6.65) and 193 subjects who developed hemorrhagic stroke (HR, 5.33; 95% CI, 3.91-7.26).

Conclusion: The risks of developing ischemic stroke and hemorrhagic stroke are significant following bacterial pneumonia infection. The risk factors, clinical outcomes, and the disease course should also be profiled to better inform the monitoring of stroke development and the clinical management of bacterial pneumonia patients.

Keywords: Bacterial pneumonia, stroke, cohort study, cardiovascular complications, clinical management, infectious etiology.

[1]
Wang H, Naghavi M, Allen C, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1459-544.
[http://dx.doi.org/10.1016/S0140-6736(16)31012-1] [PMID: 27733281]
[2]
Corrales-Medina VF, Musher DM, Shachkina S, Chirinos JA. Acute pneumonia and the cardiovascular system. Lancet 2013; 381(9865): 496-505.
[http://dx.doi.org/10.1016/S0140-6736(12)61266-5] [PMID: 23332146]
[3]
Restrepo MI, Reyes LF. Pneumonia as a cardiovascular disease. Respirology 2018; 23(3): 250-9.
[http://dx.doi.org/10.1111/resp.13233] [PMID: 29325222]
[4]
Finlayson O, Kapral M, Hall R, Asllani E, Selchen D, Saposnik G. Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology 2011; 77(14): 1338-45.
[http://dx.doi.org/10.1212/WNL.0b013e31823152b1] [PMID: 21940613]
[5]
Smith CJ, Kishore AK, Vail A, et al. Diagnosis of stroke-associated pneumonia. Stroke 2015; 46(8): 2335-40.
[http://dx.doi.org/10.1161/STROKEAHA.115.009617] [PMID: 26111886]
[6]
Westendorp WF, Nederkoorn PJ, Vermeij JD, Dijkgraaf MG, de Beek D. Post-stroke infection: A systematic review and meta-analysis. BMC Neurol 2011; 11(1): 110.
[http://dx.doi.org/10.1186/1471-2377-11-110] [PMID: 21933425]
[7]
Hannawi Y, Hannawi B, Rao CPV, Suarez JI, Bershad EM. Stroke-associated pneumonia: Major advances and obstacles. Cerebrovasc Dis 2013; 35(5): 430-43.
[http://dx.doi.org/10.1159/000350199] [PMID: 23735757]
[8]
Grossmann I, Rodriguez K, Soni M, et al. Stroke and pneumonia: Mechanisms, risk factors, management, and prevention. Cureus 2021; 13(11): e19912.
[http://dx.doi.org/10.7759/cureus.19912] [PMID: 34984111]
[9]
Chamorro Á, Meisel A, Planas AM, Urra X, van de Beek D, Veltkamp R. The immunology of acute stroke. Nat Rev Neurol 2012; 8(7): 401-10.
[http://dx.doi.org/10.1038/nrneurol.2012.98] [PMID: 22664787]
[10]
Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004; 351(25): 2611-8.
[http://dx.doi.org/10.1056/NEJMoa041747] [PMID: 15602021]
[11]
Chen LF, Chen HP, Huang YS, Huang KY, Chou P, Lee CC. Pneumococcal pneumonia and the risk of stroke: A population-based follow-up study. PLoS One 2012; 7(12): e51452.
[http://dx.doi.org/10.1371/journal.pone.0051452] [PMID: 23251538]
[12]
Warren-Gash C, Blackburn R, Whitaker H, McMenamin J, Hayward AC. Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: A self-controlled case series analysis of national linked datasets from Scotland. Eur Respir J 2018; 51(3): 1701794.
[http://dx.doi.org/10.1183/13993003.01794-2017] [PMID: 29563170]
[13]
Zysk G, Schneider-Wald BK, Hwang JH, et al. Pneumolysin is the main inducer of cytotoxicity to brain microvascular endothelial cells caused by Streptococcus pneumoniae. Infect Immun 2001; 69(2): 845-52.
[http://dx.doi.org/10.1128/IAI.69.2.845-852.2001] [PMID: 11159977]
[14]
Chen MH, Hsu JW, Huang KL, et al. Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: A nationwide population-based study. Psychol Med 2019; 49(14): 2397-404.
[http://dx.doi.org/10.1017/S003329171800332X] [PMID: 30415649]
[15]
Chen MH, Lan WH, Hsu JW, et al. Risk of developing type 2 diabetes in adolescents and young adults with autism spectrum disorder: A nationwide longitudinal study. Diabetes Care 2016; 39(5): 788-93.
[http://dx.doi.org/10.2337/dc15-1807] [PMID: 27006513]
[16]
Chen MH, Hsu JW, Huang KL, et al. Sexually transmitted infection among adolescents and young adults with attention-deficit/hyperactivity disorder: A nationwide longitudinal study. J Am Acad Child Adolesc Psychiatry 2018; 57(1): 48-53.
[http://dx.doi.org/10.1016/j.jaac.2017.09.438] [PMID: 29301669]
[17]
Zhang B, Wang HE, Bai YM, et al. Inflammatory bowel disease is associated with higher dementia risk: A nationwide longitudinal study. Gut 2021; 70(1): 85-91.
[http://dx.doi.org/10.1136/gutjnl-2020-320789] [PMID: 32576641]
[18]
Chu CS, Liang CS, Tsai SJ, et al. Bacterial pneumonia and subsequent dementia risk: A nationwide cohort study. Brain Behav Immun 2022; 103: 12-8.
[http://dx.doi.org/10.1016/j.bbi.2022.04.002] [PMID: 35390468]
[19]
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987; 40(5): 373-83.
[http://dx.doi.org/10.1016/0021-9681(87)90171-8] [PMID: 3558716]
[20]
Liu C-Y, Hung Y-T, Chuang Y-L, et al. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag 2006; 4: 1-22.
[21]
Hsieh CY, Chen CH, Li CY, Lai ML. Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database. J Formos Med Assoc 2015; 114(3): 254-9.
[http://dx.doi.org/10.1016/j.jfma.2013.09.009] [PMID: 24140108]
[22]
Corrales-Medina VF, Alvarez KN, Weissfeld LA, et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA 2015; 313(3): 264-74.
[http://dx.doi.org/10.1001/jama.2014.18229] [PMID: 25602997]
[23]
Restrepo MI, Faverio P, Anzueto A. Long-term prognosis in community-acquired pneumonia. Curr Opin Infect Dis 2013; 26(2): 151-8.
[http://dx.doi.org/10.1097/QCO.0b013e32835ebc6d] [PMID: 23426328]
[24]
Hespanhol V, Bárbara C. Pneumonia mortality, comorbidities matter? Pulmonology 2020; 26(3): 123-9.
[http://dx.doi.org/10.1016/j.pulmoe.2019.10.003] [PMID: 31787563]
[25]
Corrales-Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis 2010; 10(2): 83-92.
[http://dx.doi.org/10.1016/S1473-3099(09)70331-7] [PMID: 20113977]
[26]
Feldman C, Normark S, Henriques-Normark B, Anderson R. Pathogenesis and prevention of risk of cardiovascular events in patients with pneumococcal community‐acquired pneumonia. J Intern Med 2019; 285(6): 635-52.
[http://dx.doi.org/10.1111/joim.12875] [PMID: 30584680]
[27]
Bartlett B, Ludewick HP, Lee S, Dwivedi G. Cardiovascular complications following pneumonia. Curr Opin Cardiol 2019; 34(2): 233-9.
[http://dx.doi.org/10.1097/HCO.0000000000000604] [PMID: 30633075]
[28]
Yende S, D’Angelo G, Kellum JA, et al. Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med 2008; 177(11): 1242-7.
[http://dx.doi.org/10.1164/rccm.200712-1777OC] [PMID: 18369199]
[29]
Africano HF, Serrano-Mayorga CC, Ramirez-Valbuena PC, et al. Major adverse cardiovascular events during invasive pneumococcal disease are serotype dependent. Clin Infect Dis 2021; 72(11): e711-9.
[http://dx.doi.org/10.1093/cid/ciaa1427] [PMID: 32964223]
[30]
Feldman C, Anderson R. Prevalence, pathogenesis, therapy, and prevention of cardiovascular events in patients with community-acquired pneumonia. Pneumonia 2016; 8(1): 11.
[http://dx.doi.org/10.1186/s41479-016-0011-0] [PMID: 28702290]
[31]
Beuker C, Werring N, Bonberg N, et al. Stroke in patients with bacterial meningitis: A cohort study and meta‐analysis. Ann Neurol 2023; 93(6): 1094-105.
[http://dx.doi.org/10.1002/ana.26618] [PMID: 36806294]
[32]
Mélé N, Turc G. Stroke associated with recent mycoplasma pneumoniae infection: A systematic review of clinical features and presumed pathophysiological mechanisms. Front Neurol 2018; 9: 1109.
[http://dx.doi.org/10.3389/fneur.2018.01109] [PMID: 30622505]
[33]
Chiang CH, Huang CC, Chan WL, et al. Association between Mycoplasma pneumonia and increased risk of ischemic stroke: A nationwide study. Stroke 2011; 42(10): 2940-3.
[http://dx.doi.org/10.1161/STROKEAHA.110.608075] [PMID: 21799166]
[34]
Anand N, Kollef M. The alphabet soup of pneumonia: CAP, HAP, HCAP, NHAP, and VAP. Semin Respir Crit Care Med 2009; 30(1): 003-9.
[http://dx.doi.org/10.1055/s-0028-1119803] [PMID: 19199181]
[35]
Lee YT, Mohd Ismail NI, Wei LK. Microbiome and ischemic stroke: A systematic review. PLoS One 2021; 16(1): e0245038.
[http://dx.doi.org/10.1371/journal.pone.0245038] [PMID: 33439913]
[36]
Boden-Albala B, Sacco RL. Lifestyle factors and stroke risk: Exercise, alcohol, diet, obesity, smoking, drug use, and stress. Curr Atheroscler Rep 2000; 2(2): 160-6.
[http://dx.doi.org/10.1007/s11883-000-0111-3] [PMID: 11122740]
[37]
Yang LC, Suen YJ, Wang YH, Lin TC, Yu HC, Chang YC. The association of periodontal treatment and decreased pneumonia: A nationwide population-based cohort study. Int J Environ Res Public Health 2020; 17(1): 356.
[http://dx.doi.org/10.3390/ijerph17010356] [PMID: 31948027]
[38]
Guzik A, Bushnell C. Stroke epidemiology and risk factor management. Continuum 2017; 23(1): 15-39.
[http://dx.doi.org/10.1212/CON.0000000000000416] [PMID: 28157742]

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