Title: Association between stress hyperglycemia and pneumonia in patients with stroke: A systematic review and meta-analysis
Abstract:
Pneumonia is a frequent complication post-stroke and stress hyperglycemia (SH) is a physiological response to stroke. Some researches found that patients with SH are more likely to develop pneumonia. To investigate whether patients with SH are at an increased risk of developing pneumonia following a stroke, we carried out a systematic review and meta-analysis. A comprehensive literature search was conducted across PubMed, EBSCOhost, Web of Science, Embase, CNKI, and Wanfang databases from inception to July 10th, 2024, to identify observational studies comparing the incidence of pneumonia between stroke patients with and without SH. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS), and pooled ORs for each comparison were estimated using a random-effects model proposed by DerSimonian and Kacker. Twelve studies were included eventually and the pooled incidence rate of pneumonia was 14.5%. The overall incidence of pneumonia in patients with SH were significantly higher than those without SH (OR:1.80; 95%CI:1.56to2.07, P<0.00001). The heterogeneity was significant in meta-analysis (P=0.03, I2=48%).Through meta-regression analysis, significant differences in effect size were observed across subgroups defined by study design (P = 0.045) and the inclusion of diabetes (P = 0.038). Although some publication bias was detected, the impact of SH on pneumonia remained significant after applying the Trim and Fill method (OR=1.575; 95% CI: 1.364 to 1.819; P < 0.00001). In conclusion, patients with SH in the acute phase of stroke are 57.5% more likely to develop pneumonia than those without SH.
