Integrating the A2DS2 Score with 24-Hour ASPECTS and red cell distribution width for enhanced prediction of stroke-associated pneumonia following intravenous thrombolysis: model development and internal validation
Abstract Introduction Stroke-associated pneumonia (SAP) is a major cause of mortality during the acute phase of stroke. The A2DS2 score is widely used to predict SAP risk but does not include 24-h non-contrast computed tomography-Alberta Stroke Program Early CT Score (NCCT-ASPECTS) or red cell distr...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-025-02282-3 |
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| author | Sarawut Krongsut Nat Na-Ek Atiwat Soontornpun Niyada Anusasnee |
| author_facet | Sarawut Krongsut Nat Na-Ek Atiwat Soontornpun Niyada Anusasnee |
| author_sort | Sarawut Krongsut |
| collection | DOAJ |
| description | Abstract Introduction Stroke-associated pneumonia (SAP) is a major cause of mortality during the acute phase of stroke. The A2DS2 score is widely used to predict SAP risk but does not include 24-h non-contrast computed tomography-Alberta Stroke Program Early CT Score (NCCT-ASPECTS) or red cell distribution width (RDW). We aim to evaluate the added prognostic value of incorporating 24-h NCCT-ASPECTS and RDW into the A2DS2 score and to develop a novel prediction model for SAP following thrombolysis. Methods This retrospective cohort study included thrombolyzed AIS patients at Saraburi Hospital, Thailand. The combined A2DS2-MFP model incorporated 24-h NCCT-ASPECTS and RDW, along with non-linear continuous predictors, using multivariable fractional polynomial (MFP) regression. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AuROC), calibration plots, and decision curve analysis (DCA), comparing it with the traditional A2DS2 model and a model with continuous predictors. The goodness of fit for logistic regression models in relation to the observed data was determined through the Hosmer–Lemeshow method, and the accuracy of the probability predictions was examined using a calibration curve. Internal validation was performed using a bootstrapping approach. The predicted probability equation obtained from the final model after optimism correction was developed into a web-based application for predicting the risk of SAP, using PHP and JavaScript. Results Of 345 AIS patients, 20.3% developed SAP. The combined A2DS2-MFP model demonstrated excellent discriminative performance (AuROC: 0.917) compared to the traditional A2DS2 model (AuROC: 0.868) and the model with continuous predictors (AuROC: 0.888). Both the calibration curve and the Hosmer–Lemeshow test indicated that the predicted probabilities and observed frequencies were in acceptable agreement. Incorporating 24-h NCCT-ASPECTS and RDW significantly improved risk prediction and clinical utility, as shown by improved reclassification indices and DCA. The model was internally validated with a C-statistic of 0.912, confirming its robustness. Conclusions The combined A2DS2-MFP calculation showed superior performance, enabling early SAP detection and improving survival outcomes. This novel model offers a practical tool for resource-limited settings, supporting better SAP risk stratification and clinical management. |
| format | Article |
| id | doaj-art-2cb72c56c4984860bf46ec3a38d97c6c |
| institution | Kabale University |
| issn | 2047-783X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj-art-2cb72c56c4984860bf46ec3a38d97c6c2025-01-19T12:14:51ZengBMCEuropean Journal of Medical Research2047-783X2025-01-0130111010.1186/s40001-025-02282-3Integrating the A2DS2 Score with 24-Hour ASPECTS and red cell distribution width for enhanced prediction of stroke-associated pneumonia following intravenous thrombolysis: model development and internal validationSarawut Krongsut0Nat Na-Ek1Atiwat Soontornpun2Niyada Anusasnee3Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saraburi HospitalDivision of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of PhayaoDivision of Neurology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai UniversityDivision of Radiology, Saraburi HospitalAbstract Introduction Stroke-associated pneumonia (SAP) is a major cause of mortality during the acute phase of stroke. The A2DS2 score is widely used to predict SAP risk but does not include 24-h non-contrast computed tomography-Alberta Stroke Program Early CT Score (NCCT-ASPECTS) or red cell distribution width (RDW). We aim to evaluate the added prognostic value of incorporating 24-h NCCT-ASPECTS and RDW into the A2DS2 score and to develop a novel prediction model for SAP following thrombolysis. Methods This retrospective cohort study included thrombolyzed AIS patients at Saraburi Hospital, Thailand. The combined A2DS2-MFP model incorporated 24-h NCCT-ASPECTS and RDW, along with non-linear continuous predictors, using multivariable fractional polynomial (MFP) regression. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AuROC), calibration plots, and decision curve analysis (DCA), comparing it with the traditional A2DS2 model and a model with continuous predictors. The goodness of fit for logistic regression models in relation to the observed data was determined through the Hosmer–Lemeshow method, and the accuracy of the probability predictions was examined using a calibration curve. Internal validation was performed using a bootstrapping approach. The predicted probability equation obtained from the final model after optimism correction was developed into a web-based application for predicting the risk of SAP, using PHP and JavaScript. Results Of 345 AIS patients, 20.3% developed SAP. The combined A2DS2-MFP model demonstrated excellent discriminative performance (AuROC: 0.917) compared to the traditional A2DS2 model (AuROC: 0.868) and the model with continuous predictors (AuROC: 0.888). Both the calibration curve and the Hosmer–Lemeshow test indicated that the predicted probabilities and observed frequencies were in acceptable agreement. Incorporating 24-h NCCT-ASPECTS and RDW significantly improved risk prediction and clinical utility, as shown by improved reclassification indices and DCA. The model was internally validated with a C-statistic of 0.912, confirming its robustness. Conclusions The combined A2DS2-MFP calculation showed superior performance, enabling early SAP detection and improving survival outcomes. This novel model offers a practical tool for resource-limited settings, supporting better SAP risk stratification and clinical management.https://doi.org/10.1186/s40001-025-02282-3ASPECTSA2DS2 scoreIschemic strokeStroke-associated pneumoniaThrombolysis |
| spellingShingle | Sarawut Krongsut Nat Na-Ek Atiwat Soontornpun Niyada Anusasnee Integrating the A2DS2 Score with 24-Hour ASPECTS and red cell distribution width for enhanced prediction of stroke-associated pneumonia following intravenous thrombolysis: model development and internal validation European Journal of Medical Research ASPECTS A2DS2 score Ischemic stroke Stroke-associated pneumonia Thrombolysis |
| title | Integrating the A2DS2 Score with 24-Hour ASPECTS and red cell distribution width for enhanced prediction of stroke-associated pneumonia following intravenous thrombolysis: model development and internal validation |
| title_full | Integrating the A2DS2 Score with 24-Hour ASPECTS and red cell distribution width for enhanced prediction of stroke-associated pneumonia following intravenous thrombolysis: model development and internal validation |
| title_fullStr | Integrating the A2DS2 Score with 24-Hour ASPECTS and red cell distribution width for enhanced prediction of stroke-associated pneumonia following intravenous thrombolysis: model development and internal validation |
| title_full_unstemmed | Integrating the A2DS2 Score with 24-Hour ASPECTS and red cell distribution width for enhanced prediction of stroke-associated pneumonia following intravenous thrombolysis: model development and internal validation |
| title_short | Integrating the A2DS2 Score with 24-Hour ASPECTS and red cell distribution width for enhanced prediction of stroke-associated pneumonia following intravenous thrombolysis: model development and internal validation |
| title_sort | integrating the a2ds2 score with 24 hour aspects and red cell distribution width for enhanced prediction of stroke associated pneumonia following intravenous thrombolysis model development and internal validation |
| topic | ASPECTS A2DS2 score Ischemic stroke Stroke-associated pneumonia Thrombolysis |
| url | https://doi.org/10.1186/s40001-025-02282-3 |
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