Abstract TP117: Occurrence and Predictors of 90-Day Acute Ischemic Stroke Readmission Following Pneumonia: Analysis of Nationwide Readmissions Database

Introduction: Patients with pneumonia are at risk for acute ischemic stroke in the convalescent period. However, the national estimates of acute ischemic stroke in the convalescent period of pneumonia are not known. Objective: To identify the rate of occurrence and predictors of acute ischemic stroke in patients admitted with pneumonia in the United States. Methods: We analyzed data of adults hospitalized with pneumonia in the United States between 2018 and 2020 from the Nationwide Readmissions Database (NRD). Patients admitted with pneumonia were identified using International Classification of Disease (ICD)-10 codes (J12, J13, J14, J16, J17, J18, A481). The primary outcome used was 90-day readmission with a primary diagnosis of acute ischemic stroke (AIS) (I63) or acute myocardial infarction (MI) (I21). Multivariable logistic regression was done to identify independent predictors of acute ischemic stroke within 90-days of admission for pneumonia. Results: Among 19,505,195 patients admitted with pneumonia, 114,540 patients (0.58%) were readmitted within ninety days with MI or AIS. The median time between pneumonia to AIS readmission was 78 days (interquartile range (IQR): 30-159), with in-hospital mortality observed in 10% of patients with AIS. Independent predictors for new AIS included prior stroke (odds ratio [OR] 2.22; 95% confidence interval [CI] 2.11-2.32), cigarette smoking (OR 1.43; 95% CI 1.17-1.75), atrial fibrillation (OR 1.31; 95% CI 1.25-1.37), hypertension (OR 1.37; 95% CI 1.29-1.45), diabetes mellitus (OR 1.26; 95% CI 1.21-1.31), heart failure (OR 1.26; 95% CI 1.20-1.31), cancer (OR 1.35; 95% CI 1.27-1.43), and peripheral vascular disease (OR 1.33; 95% CI 1.21-1.45). Lower odds for new AIS were observed in viral pneumonia (OR 0.76), Coronavirus Disease (COVID)-19 pneumonia (OR 0.38), liver failure (OR 0.54), and palliative care (OR 0.22) patients. Conclusions: Our findings highlight the importance of comorbidity-based risk stratification and the need for targeted post-discharge surveillance and secondary prevention strategies, potentially beginning during the initial hospitalization for pneumonia.