Analyzing the nonlinear association between length of hospital stay and post-stroke pneumonia risk a secondary analysis of the Henan Province stroke registry
Abstract
Background and objective Post-stroke pneumonia (SAP) is a common and serious complication in patients with acute ischemic stroke, associated with poor outcomes. Length of hospital stay (LOS) may influence SAP risk, but the dose–response relationship remains unclear. This study aimed to investigate the nonlinear association between LOS and SAP and identify potential inflection points. Methods This secondary analysis of the Henan Province Stroke Registry included 926 acute ischemic stroke patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2009 to December 2012. Multivariable logistic regression models were used to assess the association between LOS and SAP. A two-piecewise linear model was applied to detect threshold effects, with multiple imputation for missing data. Results The overall SAP incidence was 20.4%. After adjusting for age, sex, comorbidities, and NIHSS score, each additional day of LOS increased SAP risk by 8.3% (adjusted OR = 1.083; 95% CI: 1.057–1.110). Nonlinear analysis revealed a significant two-phase relationship with an inflection point at 17 days: OR = 1.182 (95% CI: 1.098–1.273) for LOS < 17 days, and OR = 1.049 (95% CI: 1.015–1.084) for ≥17 days (P for log-likelihood ratio test = 0.010). Conclusion LOS is positively associated with SAP in a nonlinear manner, with a steeper risk increase during the first 17 days of hospitalization. These findings suggest intensified respiratory monitoring early in admission and…
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Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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