Temporal Profile of Stroke-Associated Pneumonia and Deep Vein Thrombosis after Stroke

INTRODUCTION: Post-stroke complications pose significant challenges in the management of stroke patients and are associated with adverse outcomes. The potential interplay and temporal sequence of stroke-associated pneumonia (SAP) and deep vein thrombosis (DVT) following stroke remain unclear. This study aimed to investigate the association between SAP and DVT and to elucidate temporal sequence of these complications after acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). METHODS: We conducted a study using the in-hospital Medical Complications after Acute Stroke (iMCAS) registry at Beijing Tiantan Hospital from 2014 to 2016. We documented the incidence of SAP and DVT and the time from stroke onset to diagnosis of each complication. A time-dependent Cox regression model was used to evaluate the association between SAP and DVT and the temporal sequence was compared across AIS, ICH, and SAH. RESULTS: A total of 1771 patients were included, comprising 1129 with AIS, 314 with ICH, and 328 with SAH. The incidence of SAP was higher than that of DVT in AIS (7.6% vs 1.9%), ICH (18.8% vs 5.7%) and SAH (16.8% vs 7.9%). SAP occurrence was significantly associated with subsequent DVT development (HR = 3.65, 95% CI: 2.08-6.40, P < 0.001). This association was also confirmed in AIS and ICH. The median time from stroke onset to SAP was 4 days (IQR: 2-6), and to DVT was 8 days (IQR: 5-12). SAP occurred significantly earlier than DVT in all stroke subtypes. CONCLUSION: SAP was significantly associated with an increased risk of subsequent DVT, with a consistent temporal sequence in which SAP preceded DVT.