Aetiology of Acute Respiratory Insufficiency in Patients With Ischaemic Stroke Studied by Chest CT Scan

Abstract

Background

Acute respiratory insufficiency (ARI) is considered a serious life-threatening complication after ischaemic stroke. The aim of this study was to identify the most common aetiologies of ARI after stroke and their association with patients' outcome.

Methods

This retrospective study was conducted at the University Hospital Bonn, involving patients with acute ischaemic stroke who underwent chest CT scans for ARI between 2017 and 2022. We collected clinical and demographic data, laboratory parameters, vital signs, as well as outcome parameters. CT scans were reviewed by a radiologist. The dataset was analysed to identify the most frequent aetiologies and their associations to outcome parameters.

Results

We included 236 patients with a median age of 75 years and a median NIHSS score of 11. In-hospital mortality accounted for 30.5%. The most frequent pulmonary conditions on CT, in order of prevalence, included bronchitis/bronchiolitis (66.1%), atelectasis (66.1%), pleural effusion (60.6%), pneumonia (53%), pulmonary oedema (37.3%), and pulmonary artery embolism (27.5%). Bronchitis/bronchiolitis was an independent risk factor for mortality (OR = 3.17, 95% CI: 1.11–8.79, p = 0.03). A higher number of pulmonary conditions decreased the likelihood of discharge to home, and non-survivors had worse vital/laboratory parameters.

Conclusions

We identified six key pulmonary aetiologies of ARI after ischaemic stroke, with bronchitis/bronchiolitis notably linked to in-hospital mortality in our study cohort. An increased number of these acute pulmonary conditions decreased the likelihood of discharge to home. Early chest CT/CT-angiography may help to identify patients at high risk for in-hospital mortality and to initiate appropriate treatment early.