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Aspiration pneumonia in patients with stroke, northeast nigeria

Objectives: Aspiration pneumonia is a common complication in patients with stroke, having a negative influence on morbidity and mortality. This study sought to assess the frequency of aspiration pneumonia and the independent predictors for its development among Nigerian patients with stroke. 
Methods: Five hundred and twenty-four stroke patients were prospectively enrolled during the study period at the University of Maiduguri Teaching Hospital, Maiduguri, from January 2005 and May 2011. All patients who developed aspiration pneumonia during hospital stay and follow–up were recorded.  A student’s t-test and a Pearson chi-square analysis was used to compare baseline characteristics of subjects who developed aspiration pneumonia and those who did not. A multiple logistic regression was used to assess the independent predictors of aspiration pneumonia. We also recorded the rate of deaths and duration hospital stay within this period. 
Results: Aspiration pneumonia occurred in 65 (12.4%) of our stroke patients, A univariate analysis showed that patients with aspiration pneumonia were older (P<0.001), had a lower Glasgow coma score on presentation (P<0.001), were more likely to have swallowing (P<0.001) and speech problems (P=0.003). They were also more likely to have severe stroke (NIHSS, P<0.001) and disability (mRDS, P<0.001; Barthel’ ADL index, P<0.001) both on admission and discharge. They had a higher 60 – day fatality (75.4% versus 9.4%; P<0.001) and a lower duration of stay (25.3±17.5 versus 34.6±28.3; P=0.01). Factors associated with the development of aspiration pneumonia are; Age > 60 years (OR, 2.3; 95% CI, 1.37 – 3.91; P=0.002); Initial GCS≤12 (OR, 4.5; 95% CI, 2.60 – 8.00; P<0.001); dysphagia (OR, 12.1; 95% CI, 6.50 – 22.70; P<0.001); dysphasia (OR, 2.2; 95% CI, 1.29 – 3.70; P=0.004); admission mRDS≥4 (OR, 4.1; 95% CI, 1.43 – 11.50; P=0.008); admission NIHSS≥11 (OR, 2.5; 95% CI, 1.34 – 4.66; P=0.004); admission Barthel’ ADL index <30 (OR, 16.9; 95% CI , 4.07 – 70.29; P<0.001). 
Conclusion: Aspiration pneumonia is a common complication in our stroke patients. Decline in consciousness, swallowing and speech difficulties, and severe strokes are associated with the development of aspiration pneumonia.