# Impact of Pneumonia on Rehabilitation Outcomes: A Large Observational Study

## TL;DR

This study shows that pneumonia after a stroke worsens recovery, increases hospital stays, and raises mortality, especially when it occurs later in hospital.

## Contribution

The study identifies hospital-acquired pneumonia as a stronger predictor of poor rehabilitation outcomes than stroke-associated pneumonia.

## Key findings

- Pneumonia after stroke significantly increases disability and mortality at 3 and 6 months.
- Hospital-acquired pneumonia is more strongly linked to poor outcomes than stroke-associated pneumonia.
- Stroke severity remains a major predictor of rehabilitation outcomes.

## Abstract

•This study compares stroke-associated pneumonia, hospital-acquired pneumonia (HAP), poststroke nonpneumonia groups for poststroke pneumonia (PSP) on rehab outcomes.•PSP, especially HAP, increased disability, mortality, and hospital stays.•Highlights need for early pneumonia detection in poststroke care in Vietnam.

This study compares stroke-associated pneumonia, hospital-acquired pneumonia (HAP), poststroke nonpneumonia groups for poststroke pneumonia (PSP) on rehab outcomes.

PSP, especially HAP, increased disability, mortality, and hospital stays.

Highlights need for early pneumonia detection in poststroke care in Vietnam.

To evaluate the effect of poststroke pneumonia on rehabilitation outcomes in patients with acute stroke.

A prospective observational cohort study.

Rehabilitation services for patients with stroke across 3 hospitals in a low and middle-income country.

A total of 922 patients with stroke (N=922) were enrolled (median age: 67y; 63.7% men) and classified into poststroke pneumonia (PSP; n=296) and nonpneumonia (PSNP; n=626) groups. The patients with PSP were further divided into 2 subgroups based on onset timing including stroke-associated pneumonia (SAP; n=157), defined as diagnosis within 7 days of stroke onset, and hospital-acquired pneumonia (HAP; n=139), defined as pneumonia diagnosed after 7 days.

Not applicable.

Primary outcome analysis focused on functional outcomes (modified Rankin Scale [mRS]), hospital length of stay (LOS), and mortality were assessed at discharge, 3 months, and 6 months after stroke. Secondary analysis explored predictors of functional outcomes.

Patients with PSP demonstrated significantly poorer functional outcomes, with higher mRS scores (≥3) at discharge, 3 months, and 6 months (P<.001). However, HAP showed stronger association with poor outcomes (odds ratio [OR]≥3) than SAP. Mortality was higher in the PSP group compared with the PSNP group at 3 months (OR=4.98; 95% CI, 2.1-11.7, P<.001) and 6 months after stroke (OR=5.4; 95% CI, 2.3-12.6, P<.001). HAP also associated with a longer LOS (24.18±7.81d) than SAP (19.5±8.26d; P<.001). Stroke severity remained a strong predictor of outcomes in this study.

Poststroke pneumonia worsens rehabilitation outcomes, prolongs LOS, and increases mortality. Early pneumonia prevention and multidisciplinary integrated rehabilitation, aligned with World Health Organization (WHO) standards, are essential to improve stroke recovery and reduce complications in low- and middle-income countries.